Can Chest Ultrasonography Substitute Standard Chest Radiography for Evaluation of Acute Dyspnea in the Emergency Department?
Chest. 2010 Oct 14;
Authors: Zanobetti M, Poggioni C, Pini R
ABSTRACT BACKGROUND: We examined the concordance between chest ultrasonography (US) and chest X-ray in patients with dyspnea, using chest computerized tomography (CT) as gold standard in case of mismatch between the two modalities. METHODS: A prospective blinded observational study was conducted in the Emergency Department (ED) of a university-affiliated teaching hospital. All consecutive patients presenting for dyspnea during a single Emergency Physician shift were enrolled independently from the underlying disease; only patients with trauma were excluded. RESULTS: Both US and X-ray were performed in 404 patients; CT was performed in 118 patients. US interpretation was completed during the scan, while the average time between X-ray request and its final interpretation was 1 hour and 35 minutes. US and X-ray exhibited high concordance in most pulmonary diseases, especially in pulmonary edema (K=95%). For lung abnormalities like free pleural effusion, loculated pleural effusion, pneumothorax, and lung consolidation the concordance was similar for both left and right lungs (all p=NS). When US and X-ray gave discordant results, CT confirmed the US findings in 63% of patients (p<0.0001). Particularly, US exhibited greater sensitivity than X-ray in patients with free pleural effusion (p< 0.0001). CONCLUSIONS: When performed by one highly trained physician, our study demonstrated high concordance between US and X-ray. When US and X-ray disagreed, US proved to be more accurate than X-ray in distinguishing free pleural effusion. Thus, considering the short time needed to have a final US report, this technique could become the routine imaging modality for dyspneic patients presenting to the ED.
PMID: 20947649 [PubMed - as supplied by publisher]