Lung ultrasound is a useful tool for diagnosing pneumonia with a sensitivity of 85% and specificity of 93% according to this meta-analysis of 20 studies. It was found to have higher diagnostic accuracy than chest radiography with an area under the ROC curve of 0.978. The studies evaluated over 2500 patients of all ages and generally had low risk of bias. However, there was moderate heterogeneity between the studies. Further research directly comparing lung ultrasound to chest x-ray is still needed to prove its clinical usefulness.

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
!