Dr. Tom Colletti, DHSc, PA-C, DFAAPA
Introduction: Pneumonia is a challenging diagnosis for military providers in a deployed setting because they are commonly restricted to only their clinical examination. This article aims to synthesize the best available evidence to determine the feasibility and utility of ultrasound in diagnosing pneumonia in deployed and austere environments.
Materials and Methods: A literature search was conducted across multiple databases, including Medline, Embase, Scopus, and Cochrane. Search terms included pneumonia, point of care ultrasound, ultrasound, chest radiograph, and emergency medicine. Diagnostic characteristics identified included sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratios, and area under the curve. Chest radiograph findings, patient positioning, and specific ultrasound findings were also identified.
Results: Seven systematic reviews and meta-analyses met the search criteria, including rigorous analysis, standard comparison, and population characteristics. The review found ultrasound sensitivity ranging from 80%-95% and specificity 70%-96%. Positive and negative likelihood ratios were 5.37-16.8 and 0.07-0.13, respectively. Diagnostic odds ratios spanned 50 to 180.6, and the area under the curve findings were 90% to 99%. The patient position was found to influence diagnostic accuracy, with the best position being supine or semi-recumbent for posterior views and seated for lateral views. The most sensitive ultrasound finding was a focal interstitial syndrome, while the most specific was c-profile. Comparison diagnostic accuracy for chest radiograph was limited; however, the studies that included it noted a sensitivity and specificity of 76% and 91%.
Conclusion: Lung ultrasound shows promise as a tool in diagnosing pneumonia in adult patients, with better sensitivity and specificity than chest radiography. Nevertheless, the level of training needed for accurate diagnoses and the best protocol for detection remains unclear. No studies directly evaluated ultrasound-guided pneumonia diagnosis in low-resource or deployed environments, identifying a practice gap for further research. Military medical professionals should consider ultrasound a valuable tool in their facilities; however, they must develop best practices to diagnose pneumonia at the bedside accurately.
Keywords: Point of care ultrasound, ultrasound, chest radiograph, pneumonia, emergency medicine
Tentis M. Lung Ultrasound for Diagnosing Pneumonia in Deployed Military Settings. Lynchburg Journal of Medical Science. 2021; 4(1).
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