TY - JOUR
T1 - Handheld Ultrasound Devices Used by Newly Certified Operators for Pneumonia in the Emergency Department-A Diagnostic Accuracy Study
AU - Lorentzen, Morten Jongshøj
AU - Kristensen, Anne Heltborg
AU - Kaldan, Frida Poppius
AU - Cartuliares, Mariana Bichuette
AU - Hertz, Mathias Amdi
AU - Specht, Jens Juel
AU - Posth, Stefan
AU - Lindberg, Mats Jacob Hermansson
AU - Skaarup, Søren Helbo
AU - Hansen, Meinhard Reinert
AU - Spile, Camilla Stræde
AU - Andersen, Michael Brun
AU - Graumann, Ole
AU - Mogensen, Christian Backer
AU - Skjøt-Arkil, Helene
AU - Laursen, Christian B
PY - 2024/8/30
Y1 - 2024/8/30
N2 - The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR ( p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard ( p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.
AB - The diagnostic accuracy of handheld ultrasound (HHUS) devices operated by newly certified operators for pneumonia is unknown. This multicenter diagnostic accuracy study included patients prospectively suspected of pneumonia from February 2021 to February 2022 in four emergency departments. The index test was a 14-zone focused lung ultrasound (FLUS) examination, with consolidation with air bronchograms as diagnostic criteria for pneumonia. FLUS examinations were performed by newly certified operators using HHUS. The reference standard was computed tomography (CT) and expert diagnosis using all medical records. The sensitivity and specificity of FLUS and chest X-ray (CXR) were compared using McNemar's test. Of the 324 scanned patients, 212 (65%) had pneumonia, according to the expert diagnosis. FLUS had a sensitivity of 31% (95% CI 26-36) and a specificity of 82% (95% CI 78-86) compared with the experts' diagnosis. Compared with CT, FLUS had a sensitivity of 32% (95% CI 27-37) and specificity of 81% (95% CI 77-85). CXR had a sensitivity of 66% (95% CI 61-72) and a specificity of 76% (95% CI 71-81) compared with the experts' diagnosis. Compared with CT, CXR had a sensitivity of 69% (95% CI 63-74) and a specificity of 68% (95% CI 62-72). Compared with the experts' diagnosis and CT diagnosis, FLUS performed by newly certified operators using HHUS devices had a significantly lower sensitivity for pneumonia when compared to CXR ( p < 0.001). FLUS had a significantly higher specificity than CXR using CT diagnosis as a reference standard ( p = 0.02). HHUS exhibited low sensitivity for pneumonia when used by newly certified operators.
U2 - 10.3390/diagnostics14171921
DO - 10.3390/diagnostics14171921
M3 - Journal article
C2 - 39272706
SN - 2075-4418
VL - 14
JO - Diagnostics
JF - Diagnostics
IS - 17
ER -