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- Title
The impact of lung ultrasound on clinical-decision making across departments: a systematic review.
- Authors
Heldeweg, Micah L. A.; Vermue, Lian; Kant, Max; Brouwer, Michelle; Girbes, Armand R. J.; Haaksma, Mark E.; Heunks, Leo M. A.; Mousa, Amne; Smit, Jasper M.; Smits, Thomas W.; Paulus, Frederique; Ket, Johannes C. F.; Schultz, Marcus J.; Tuinman, Pieter Roel
- Abstract
Background: Lung ultrasound has established itself as an accurate diagnostic tool in diferent clinical settings. However, its efects on clinical-decision making are insufciently described. This systematic review aims to investigate the impact of lung ultrasound, exclusively or as part of an integrated thoracic ultrasound examination, on clinical-decision making in diferent departments, especially the emergency department (ED), intensive care unit (ICU), and general ward (GW). Methods: This systematic review was registered at PROSPERO (CRD42021242977). PubMed, EMBASE, and Web of Science were searched for original studies reporting changes in clinical-decision making (e.g. diagnosis, management, or therapy) after using lung ultrasound. Inclusion criteria were a recorded change of management (in percentage of cases) and with a clinical presentation to the ED, ICU, or GW. Studies were excluded if examinations were beyond the scope of thoracic ultrasound or to guide procedures. Mean changes with range (%) in clinical-decision making were reported. Methodological data on lung ultrasound were also collected. Study quality was scored using the Newcastle–Ottawa scale. Results: A total of 13 studies were included: fve studies on the ED (546 patients), fve studies on the ICU (504 patients), two studies on the GW (1150 patients), and one study across all three wards (41 patients). Lung ultrasound changed the diagnosis in mean 33% (15–44%) and 44% (34–58%) of patients in the ED and ICU, respectively. Lung ultrasound changed the management in mean 48% (20–80%), 42% (30–68%) and 48% (48–48%) of patients in the ED, in the ICU and in the GW, respectively. Changes in management were non-invasive in 92% and 51% of patients in the ED and ICU, respectively. Lung ultrasound methodology was heterogeneous across studies. Risk of bias was moderate to high in all studies. Conclusions: Lung ultrasound, exclusively or as a part of thoracic ultrasound, has substantial impact on clinicaldecision making by changing diagnosis and management in the EDs, ICUs, and GWs. The current evidence level and methodological heterogeneity underline the necessity for well-designed trials and standardization of methodology.
- Subjects
SYSTEMATIC reviews; MEDICAL decision making; PULMONARY function tests; INTENSIVE care units; ULTRASONIC imaging; EVIDENCE-based medicine
- Publication
Ukrainian Journal of Ecology, 2022, Vol 12, Issue 12, p1
- ISSN
2520-2138
- Publication type
Article
- DOI
10.1186/s13089-021-00253-3