Objectives– To compare the diagnostic accuracy of bedside chest ultrasound vs chest X-ray in a cohort of frail multimorbid elderly acutely hospitalized with respiratory symptoms. Methods– 97 frail (Rockwood score≥4) multimorbid (≥3 chronic comorbidities) elderly (age≥65, median 84, IQR 78-89) admitted to an acute-care geriatric ward with sudden-onset respiratory complaints (cough, dyspnea, hemoptysis, pleuritic pain) were consecutively evaluated with a standard chest X-ray, carried out in a radiology unit, and a bedside chest ultrasound, performed by clinicians of the admitting ward. Chest contrast-enhanced CT was performed only if other tests’ results were inconclusive. Ultrasound and X-ray results were blindly categorized as positive or negative by an expert clinician. Diagnostic accuracy, sensitivity and sensibility of chest ultrasound and X-ray for the main diagnoses (i.e. heart failure, pneumonia, pleural effusion) were calculated. Results- Overall diagnostic accuracy for pneumonia (46 patients) was higher for ultrasound (92%vs72%), that proved more sensitive than X-ray (92%vs53%) and similarly specific (98%vs94%). Similar results were also obtained for pleural effusion (21 patients, accuracy 94% ultrasound vs 67% X-ray, sensitivity 97%vs59%, specificity 96%vs96%), but not for heart failure, where diagnostic performance was equal (accuracy 84%vs83%, sensitivity 69%vs67%, specificity 97%vs97%). Chest CT was necessary for diagnosis only in 17% of cases, while in 44 cases out of 97 (45%) ultrasound allowed to establish diagnosis despite negative X-ray, thus preventing a CT prescription. Conclusions- Bedside chest ultrasound can be an accurate and effective part of diagnostic workup for frail multimorbid elderly with respiratory symptoms, improving appropriateness in chest CT prescriptions.

Chest ultrasound for the diagnosis of acute respiratory diseases in frail multimorbid hospitalized elderly / Ticinesi, Andrea; Nouvenne, Antonio; Zani, MARCO DAVID; Folesani, Giuseppina; Guida, Loredana; Morelli, Ilaria; Prati, Beatrice; Lauretani, Fulvio; Maggio, Marcello Giuseppe; Meschi, Tiziana. - In: EUROPEAN GERIATRIC MEDICINE. - ISSN 1878-7649. - 6:(2015), pp. S12-S13.

Chest ultrasound for the diagnosis of acute respiratory diseases in frail multimorbid hospitalized elderly

TICINESI, Andrea;NOUVENNE, ANTONIO;ZANI, MARCO DAVID;FOLESANI, GIUSEPPINA;GUIDA, Loredana;MORELLI, Ilaria;PRATI, Beatrice;LAURETANI, Fulvio;MAGGIO, Marcello Giuseppe;MESCHI, Tiziana
2015-01-01

Abstract

Objectives– To compare the diagnostic accuracy of bedside chest ultrasound vs chest X-ray in a cohort of frail multimorbid elderly acutely hospitalized with respiratory symptoms. Methods– 97 frail (Rockwood score≥4) multimorbid (≥3 chronic comorbidities) elderly (age≥65, median 84, IQR 78-89) admitted to an acute-care geriatric ward with sudden-onset respiratory complaints (cough, dyspnea, hemoptysis, pleuritic pain) were consecutively evaluated with a standard chest X-ray, carried out in a radiology unit, and a bedside chest ultrasound, performed by clinicians of the admitting ward. Chest contrast-enhanced CT was performed only if other tests’ results were inconclusive. Ultrasound and X-ray results were blindly categorized as positive or negative by an expert clinician. Diagnostic accuracy, sensitivity and sensibility of chest ultrasound and X-ray for the main diagnoses (i.e. heart failure, pneumonia, pleural effusion) were calculated. Results- Overall diagnostic accuracy for pneumonia (46 patients) was higher for ultrasound (92%vs72%), that proved more sensitive than X-ray (92%vs53%) and similarly specific (98%vs94%). Similar results were also obtained for pleural effusion (21 patients, accuracy 94% ultrasound vs 67% X-ray, sensitivity 97%vs59%, specificity 96%vs96%), but not for heart failure, where diagnostic performance was equal (accuracy 84%vs83%, sensitivity 69%vs67%, specificity 97%vs97%). Chest CT was necessary for diagnosis only in 17% of cases, while in 44 cases out of 97 (45%) ultrasound allowed to establish diagnosis despite negative X-ray, thus preventing a CT prescription. Conclusions- Bedside chest ultrasound can be an accurate and effective part of diagnostic workup for frail multimorbid elderly with respiratory symptoms, improving appropriateness in chest CT prescriptions.
2015
Chest ultrasound for the diagnosis of acute respiratory diseases in frail multimorbid hospitalized elderly / Ticinesi, Andrea; Nouvenne, Antonio; Zani, MARCO DAVID; Folesani, Giuseppina; Guida, Loredana; Morelli, Ilaria; Prati, Beatrice; Lauretani, Fulvio; Maggio, Marcello Giuseppe; Meschi, Tiziana. - In: EUROPEAN GERIATRIC MEDICINE. - ISSN 1878-7649. - 6:(2015), pp. S12-S13.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2795942
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