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. 2014;13(4):29-40.

Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis

Ali Ebrahimi  1 , Mahmoud Yousefifard  2 , Hossein Mohammad Kazemi  1 , Hamid Reza Rasouli  1 , Hadi Asady  3 , Ali Moghadas Jafari  4 , Mostafa Hosseini  5
Affiliations

Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis

Ali Ebrahimi et al. Tanaffos. 2014.

Abstract

Background: Early detection of pneumothorax is critically important. Several studies have shown that chest ultrasonography (CUS) is a highly sensitive and specific tool. The present systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of CUS and chest radiography (CXR) for detection of pneumothorax.

Materials and methods: The literature search was conducted using PubMed, EMBASE, Cochrane, CINAHL, SUMSearch, Trip databases, and review article references. Eligible articles were defined as diagnostic studies on patients suspected for pneumothorax who underwent chest computed tomography (CT) scan and those assessing the screening role of CUS and CXR.

Results: The analysis showed the pooled sensitivity and specificity of CUS were 0.87 (95% CI: 0.81-0.92; I2= 88.89, P<0.001) and 0.99 (95% CI: 0.98-0.99; I2= 86.46, P<0.001), respectively. The pooled sensitivity and specificity of CXR were 0.46 (95% CI: 0.36-0.56; I2= 85.34, P<0.001) and 1.0 (95% CI: 0.99-1.0; I2= 79.67, P<0.001), respectively. The Meta regression showed that the sensitivity (0.88; 95% CI: 0.82 - 0.94) and specificity (0.99; 95% CI: 0.98 - 1.00) of ultrasound performed by the emergency physician was higher than by non-emergency physician. Non-trauma setting was associated with higher pooled sensitivity (0.90; 95% CI: 0.83 - 0.98) and lower specificity (0.97; 95% CI: 0.95 - 0.99).

Conclusion: The present meta-analysis showed that the diagnostic accuracy of CUS was higher than supine CXR for detection of pneumothorax. It seems that CUS is superior to CXR in detection of pneumothorax, even after adjusting for possible sources of heterogeneity.

Keywords: Diagnostic tests; Pneumothorax; Radiography; Routine; Ultrasonography.

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Figures

Figure 1
Figure 1
Flow chart of the study. Diagram represents the review process and selection of included studies
Figure 2
Figure 2
Deeks’ funnel plot for publication bias assessment of CUS (A) and CXR (B) for diagnosis of pneumothorax
Figure 3
Figure 3
Forest plot for sensitivity and specificity of CUS for diagnosis of pneumothorax.
Figure 4
Figure 4
Forest plot for sensitivity and specificity of CUS for detection of pneumothorax.
Figure 5
Figure 5
Forest plot for diagnostic odds ratio (DOR) of US (A) and CXR (B).
Figure 6
Figure 6
Summary receiver operative curves for US (A) and CXR (B). AUC, Area under the curve
See this image and copyright information in PMC

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