Diagnostic Accuracy of Point-of-Care Ultrasound versus Chest Radiography in Pleural Effusion: A Systematic Review and Meta-Analysis
Keywords:
Point-Of-Care Ultrasound (POCUS), Chest Radiography, Pleural Effusion, Diagnostic AccuracyAbstract
Background: Pleural effusion is a widely encountered clinical disorder in which excessive fluid develops in the pleural space from a variety of underlying disease processes, including heart failure, malignancy, and pneumonia, etc. Early and precise identification of pleural effusion ultimately leads to appropriate management. Point-of-care ultrasound (POCUS) has arisen as a possible method for diagnosing pleural effusion in lieu of an examination with standard chest radiography (CXR), although the diagnostic accuracy of POCUS still remains disputed. Objective: To systematically evaluate and compare the diagnostic accuracy of point-of-care ultrasound (POCUS) and chest radiography for the detection of pleural effusion. Methodology: A systematic review and meta-analysis were conducted for comparative diagnostic accuracy with point of care ultrasound (POCUS) and chest radiograph (CXR) for the detection of pleural effusion. Data were pooled from 20 studies constituting 2,905 patient encounters. Sensitivity and specificity were calculated using the DerSimonian - Laird random-effects model. Subgroup analysis was performed to assess the effect of patient position, operator experience, and reference standard on diagnostic accuracy. Results: The pooled sensitivity of point of care ultrasound (POCUS) was 95.8% (95% CI:93.4-98.2%) and specificity was 98.1% (95% CI:96.9-99.3%). The pooled sensitivity of chest radiography (CXR) was 66.3% (95% CI:58.1-74.5%) and specificity was 86.5% (95% CI:81.8-91.2%). Subgroup analysis showed that evaluating patients in the lateral decubitus position improved CXR accuracy compared to supine. Conclusion: Point of care ultrasound (POCUS) has improved sensitivity and specificity compared to chest radiography (CXR) for the evaluation of pleural effusion. It is warranted to consider POCUS as a first line diagnostic tool and particularly in the developed patients in an emergency department or intensive care setting for high acuity patients. There is a need for further investigation of POCUS on long-term clinical outcomes and cost-effectiveness.References
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