Chest
Volume 141, Issue 3, March 2012, Pages 703-708
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Original Research
Pulmonary Procedures
Test Characteristics of Ultrasonography for the Detection of Pneumothorax: A Systematic Review and Meta-analysis

https://doi.org/10.1378/chest.11-0131Get rights and content

Background

A pneumothorax is a potentially life-threatening condition. Although CT scan is the reference standard for diagnosis, chest radiographs are commonly used to rule out the diagnosis. We compared the test characteristics of ultrasonography and supine chest radiography in adult patients clinically suspected of having a pneumothorax, using CT scan or release of air on chest tube placement as reference standard.

Methods

We searched for English literature in MEDLINE and EMBASE and performed hand searches. Two independent investigators used standardized forms to review articles for inclusion, quality (QUADAS tool), and data extraction. We calculated κ agreement for study selection and evaluated clinical and quality homogeneity before meta-analysis.

Results

We reviewed 570 articles and selected 21 for full review (κ, 0.89); eight articles (total of 1,048 patients) met all inclusion criteria (κ, 0.81). All studies but one used the ultrasonographic signs of lung sliding and comet tail to rule out pneumothorax. Chest radiography data were available for 864 of 1,048 patients evaluated with ultrasonography. Ultrasonography was 90.9% sensitive (95% CI, 86.5-93.9) and 98.2% specific (95% CI, 97.0-99.0) for the detection of pneumothorax. Chest radiography was 50.2% sensitive (95% CI, 43.5-57.0) and 99.4% specific (95% CI, 98.3-99.8).

Conclusions

Performance of ultrasonography for the detection of pneumothorax is excellent and is superior to supine chest radiography. Considering the rapid access to bedside ultrasonography and the excellent performance of this simple test, this study supports the routine use of ultrasonography for the detection of pneumothorax.

Section snippets

Study Design, Subjects, and Interventions

We systematically reviewed the literature for prospective studies in which chest ultrasonography was used for diagnosis in patients with clinically suspected pneumothorax of any cause. We included studies in which the reference standard used was either CT scan findings or release of air on chest tube insertion. We excluded studies on the pediatric population.

Outcome Measures and Search Strategy

Our main outcome measure was to determine the sensitivity, specificity, negative predictive value (NPV), and positive predictive value

Characteristics of Selected Studies

We completed our initial search strategy in December 2009 and identified 570 potential articles. We did not identify any unpublished studies; our electronic search strategy identified all potential studies. We repeated our electronic search on November 30, 2010 and did not identify any additional published studies since our initial query. Based on manuscript titles and abstracts, we excluded 549 papers (κ, 0.89). After reviewing the full text of 21 studies that were potentially eligible for

Discussion

In this systematic review and meta-analysis, we found that the performance of ultrasonography for the detection of pneumothorax is excellent. Ultrasonography is more sensitive than chest radiography for the detection of pneumothorax by a clinically and statistically significant margin. The performance of ultrasonography was consistent when pneumothoraces were caused by trauma or invasive procedures.

Although still performing better than chest radiography, ultrasonography sensitivity was low in

Conclusions

This study demonstrates that chest ultrasonography can help recognize pneumothoraces with a sensitivity significantly superior and a specificity clinically similar to that of supine chest radiography. Our findings support the adoption of chest ultrasonography for routine use in patients with clinically suspected pneumothoraces.

Acknowledgments

Author contributions: Dr Alrajhi: contributed to conceiving the idea for the study; writing and performing the search strategy; performing the abstraction, paper selection, and data extraction; and editing the manuscript.

Dr Woo: contributed to performing the abstraction, paper selection, data extraction, and editing the manuscript.

Dr Vaillancourt: contributed to writing and performing the search strategy, structuring the methods and performing the statistical analysis, and editing the

References (20)

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Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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