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

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.