academic teaching / Emergency medicine

1. Dr.Mohmmed Al-Shukaili

2. Diagnosis of Pneumonia
• Clinical diagnosis.
• chest radiographs are obtained unnecessarily
for patients with upper respiratory tract
infections or bronchitis.
• Computed tomography (CT) of the chest is
more sensitive than plain radiography for
detecting the presence of pulmonary
consolidation.

3. Lung ultrasound ( LUS )
• In lung ultrasound, the normal lung displays
the “lung sliding” and A-lines.

4. Lung ultrasound ( LUS )
• On LUS , consolidation is defined as tissue-like
pattern reminiscent of the liver -
“hepatization,”
• (shred sign) : The deeper border of
consolidated lung tissue that makes contact
with the aerated lung is shredded and
irregular.
• B-lines: 3 and more.

12. • Meta-analysis can be defined as a
quantitative method that mathematically
combines the results from multiple studies
covering the same overall topic, or the
statistical pooling of the results of two or
more similar studies.

13. • Aim of the study : meta-analysis for the
diagnostic power of lung ultrasound versus
chest radiological imaging for the diagnosis of
pneumonia.

14. Methods
• A systematic search of electronic databases was
conducted, including MEDLINE, EMBASE, and
Cochrane databases from 1990 to 2016.
• Intervention : US vs. imaging
• Outcome : diagnosis of pneumonia
• Comparison : other imagining modalities.
• The evaluation of pneumonia is a combination of
clinical data, laboratory results, and chest
imaging.

15. Methods
• Included all types of patients’ pneumonia.
• All age groups , ultrasound findings in both are similar.
• Two authors , screened titles and abstracts for valid
articles. Full-text articles were retrieved afterward.
• abstraction tables that includes year of publication,
patients’ baseline characteristics, and diagnostic study
data (numbers of true positive, false positive, false
negative, and true negative test results).
• Disagreement in study selection and abstraction was
resolved by discussion with the third reviewer

16. Methods
• QUADAS-2 instrument to assess the quality
assessment of the included studies
• This tool will allow for more transparent rating of
bias and applicability of primary diagnostic
accuracy studies.
• Risk of bias was judged as “Low,” “High,” or
“Unclear.”
• meta-analysis was conducted using Meta-Disc 1.4
• Heterogeneity was assessed using the I-squared
statistic and Q test.

18. Result
• 20 prospective studies were selected.
• 5 studies dealing with paediatric patients
• 2513 patients.
• Age of patients ranges from 1 month to 100
years.
• quality of all studies was generally high, had
low risk of bias, and satisfied the majority of
the risk of bias criteria.

19. Result
• Overall pooled sensitivity and specificity for diagnosis
of pneumonia by lung ultrasound were 0.85 (0.84–
0.87) and 0.93 (0.92–0.95), respectively.
• Overall pooled positive and negative LRs (Fig. 4) were
11.05
• (3.76–32.50) and 0.08 (0.04–0.15), pooled diagnostic
• Odds ratio (Fig. 5) was 173.64 (38.79–777.35), and
• area under the pooled ROC (AUC for SROC) was 0.978

27. Limitations
• Moderate-to-high degree of
inconsistency/heterogeneity.
• investigate clinical end-point to prove/disprove
LUS as a useful diagnostic strategy.
• No clear comparison between LUS and chest x-
ray.
• These clinical end-points were not addressed,as
the focus was to establish pooled diagnostic
accuracy rather than estimating effec-tiveness
between comparative diagnostic strategies.

28. Critical appraisal

29. Critical appraisal

30. Critical appraisal

31. THANK YOU
!