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In patients with suspected community acquired pneumonia, what is the diagnostic accuracy of point-of-care ultrasound versus chest x-ray?

A2018 systematic review and meta-analysis of 12 studies (nine prospective cohorts, N51,220; three retrospective cohorts, N5299) was conducted on the efficacy of lung ultrasound in diagnosis of community acquired pneumonia in pediatric populations. Studies were conducted at multiple centers in various countries (Greece, Italy, Russia, Taiwan, United States, India, and Turkey), six in an inpatient hospital setting, and six in the emergency department. Patient ages ranged from one month to 21 years old (mean age four years old, 54% male). The prevalence of community acquired pneumonia in the studied population was 81%. Patients with symptoms consistent with community acquired pneumonia were evaluated with ultrasound and chest x-ray. Both imaging modalities were compared with expert clinical diagnosis of community acquired pneumonia as the gold standard. Lung ultrasound was more sensitive (96% [95% CI, 94%–97%] vs 87% [95% CI, 83%–90%]) and equally as specific (95% [95% CI, 91%–98%] vs 98% [95%CI, 96%–99.6%]) compared with chest x-ray. This analysis was limited by its use of clinical diagnosis as the gold standard for diagnosis. A 2015 systematic review and meta-analysis was performed on five prospective cohort studies (N5742) to compare the accuracy of lung ultrasound versus chest x-ray for the diagnosis of community-acquired pneumonia in adults. Studies were conducted at multiple international centers in France, Italy, and Germany in an inpatient hospital setting. All patients were adults (mean age not provided) presenting with symptoms consistent with community acquired pneumonia. The prevalence of community acquired pneumonia in the studied population was 67%. Patients were evaluated with lung ultrasound by trained emergency physicians before being evaluated with chest x-ray. Chest computed tomography was only performed in 138 patients with equivocal or negative radiographic findings and positive lung ultrasound or in difficult diagnoses. Hospital discharge diagnosis was used as the standard reference. Lung ultrasound was more sensitive (95% [95% CI, 93%–97%] vs 77% [95% CI, 73%–80%]) and equally as specific (90% [95% CI, 86%–94%] vs 91% [95% CI, 87%–94%]) compared with chest x-ray. This analysis provided limited patient demographics with varied diagnostic (clinical diagnosis, chest x-ray, or chest computed tomography) gold standard among the studies.