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- Title
Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study.
- Authors
Rodríguez-Contreras, Francisco Javier; Calvo-Cebrián, Antonio; Díaz-Lázaro, Juncal; Cruz-Arnés, Miguel; León-Vázquez, Fernando; Lobón-Agúndez, María del Carmen; Palau-Cuevas, Francisco Javier; Henares-García, Paloma; Gavilán-Martínez, Fernando; Fernández-Plaza, Sandra; Prieto-Zancudo, Carmelo; Del Carmen Lobón-Agúndez, María
- Abstract
<bold>Purpose: </bold>We investigated whether lung ultrasound (US) performed in primary care is useful and feasible for diagnosing community-acquired pneumonia (CAP) compared with chest radiography, as most previous research has been conducted in hospital settings.<bold>Methods: </bold>We undertook a prospective observational cohort study of lung US performed in 12 primary care centers. Patients aged 5 years and older with symptoms suggesting CAP were examined with lung US (by 21 family physicians and 7 primary care pediatricians) and chest radiograph on the same day. We compared lung US findings with the radiologist's chest radiograph report as the reference standard, given that the latter is the most common imaging test performed for suspected CAP in primary care. The physicians had varied previous US experience, but all received a 5-hour lung US training program.<bold>Results: </bold>The study included 82 patients. Compared with chest radiography, positive lung US findings (consolidation measuring >1 cm or a focal/asymmetrical B-lines pattern) showed a sensitivity of 87.8%, a specificity of 58.5%, a positive likelihood-ratio of 2.12, and a negative likelihood-ratio of 0.21. Findings were similar regardless of the physicians' previous US training or experience. We propose a practical algorithm whereby patients having consolidation measuring greater than 1 cm or normal findings on lung US could skip chest radiography, whereas patients with a B-lines pattern without consolidation (given its low specificity) would need chest radiography to ensure appropriate management. Lung US was generally performed in 10 minutes or less.<bold>Conclusion: </bold>Point-of-care lung US in primary care could be useful for investigating suspected CAP (avoiding chest radiography in most cases) and is likely feasible in daily practice, as short training programs appear sufficient and little time is needed to perform the scan.
- Subjects
PNEUMONIA; RESEARCH; MEDICAL information storage &; retrieval systems; ULTRASONIC imaging; HOSPITAL emergency services; CHEST X rays; LUNGS; RESEARCH methodology; EVALUATION research; COMPARATIVE studies; COMMUNITY-acquired infections; CLINICAL medicine; SENSITIVITY &; specificity (Statistics); LONGITUDINAL method
- Publication
Annals of Family Medicine, 2022, Vol 20, Issue 3, p227
- ISSN
1544-1709
- Publication type
journal article
- DOI
10.1370/afm.2796