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Category: Volume 06 Issue 03 March 2018
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Title: Chest Ultrasound: More Sensitive and Specific than Chest X-ray in Diagnosing Pneumonia

Authors: Hemanshu Warrier, Avi Kumar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.64

Abstract

Statement of the Problem: Community-acquired pneumonia is a common and serious illness worldwide. It is the main cause of mortality, which particularly targets young patients, elderly patients and those with co morbid conditions. Most patients with pneumonia are managed in the outpatient setting but patient admitted in the hospital due to pneumonia have a high mortality. Chest ultrasound (CUS) is being increasingly utilized in emergency and critical settings. Aim of this study was to compare the sensitivity and specificity of chest ultrasound and chest x-ray.

Methodology & Theoretical Orientation: This was a prospective clinical study. We aimed for a sample size of 96 patients. Patients were enrolled every alternate day to randomise the study. Informed written consent was taken from all enrolled patients or their immediate relatives. The result of chest computerized tomography scan was taken as gold standard. The duration of study was 6 months (from September’16 to February’16). 100 patients were included in the study. Findings: Chest Ultrasound was found to have a higher sensitivity of 0.96 (95% CI 0.85 – 0.99) compared to x-ray which had a sensitivity of 0.57 (95% CI 0.42 – 0.70). Also a higher specificity was found in Chest Ultrasound compared to chest x-ray, 0.95 (95% CI 0.84-0.99) vs 0.85 (95% CI 0.71-0.93). Chest ultrasound was found to have a perfect agreement with the final diagnosis i.e k=0.91 compared to a moderate agreement between chest x-ray and the final diagnosis i.e k=0.42. The two tailed p value was 0.02 and by conventional criteria, this difference was found to be statistically significant.

Conclusion & Significance: We concluded that chest ultrasound is more sensitive and specific the chest x-ray in diagnosing patients with pneumonia. Chest ultrasound is easily available, less expensive, faster and gives off no radiation when compared to chest x-ray. We recommend that with adequate training chest ultrasound should be preferred over chest x-ray for patients in a critical care setting.

Keywords: Chest ultrasound, chest x-ray, pneumonia, Community-acquired pneumonia, sensitivity, specificity

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Corresponding Author

Hemanshu Warrier

MBBS MEM MRCEM, Head,

Emergency Department, Max Hospital, India

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