Ultrasound More Accurate Than Stethoscope for Diagnosing Pneumonia

Point-of-care (POC) ultrasound is more accurate than the traditional auscultation by stethoscope in diagnosing pneumonia in children and young adults, according to a new study.

Researchers at Mount Sinai Hospital (New York, NY, USA) reviewed 200 patients (ages birth to 21 years) who visited the Bellevue Hospital Center (New York, NY, USA) emergency department (ED) with suspected community acquired pneumonia (CAP) at from 2008-2010. The criteria for inclusion were patients requiring a chest X-ray for evaluation. Clinicians adept at ultrasonography examined the patients after being given one hour of focused training prior to the start of the study on the use the ultrasound to diagnose pneumonia.

The researchers found POC ultrasound to be highly specific (97%) for diagnosing pneumonia, with sensitivity as high as 92% that can be achieved with training and experience. The accuracy for diagnosing pneumonia with the stethoscope was lower: specificity ranged from 77%–83%, and sensitivity at 24%. Further analysis of the data revealed that ultrasound was also able to identify pneumonia too small (less than 1 cm diameter) for a chest X-ray to detect in 12 out of 48 patients with confirmed pneumonia. The study was published early online on December 10, 2012, in Archives of Pediatrics & Adolescent Medicine.

“The World Health Organization (WHO; Geneva, Switzerland) has estimated as many as three-quarters of the world's population, especially in the developing world, does not have access to any diagnostic imaging, such as chest X-ray, to detect pneumonia,” said senior author associate professor James Tsung, MD, MPH. “Many children treated with antibiotics may only have a viral infection - not pneumonia. Portable ultrasound machines can provide a more accurate diagnosis of pneumonia than a stethoscope.”

The researchers also noted that diagnosing pneumonia with a stethoscope can be more difficult when a patient is wheezing or has coexisting diseases such as asthma or bronchiolitis, a problem that does not exist for ultrasound.

Related Links:
Mount Sinai Hospital
Bellevue Hospital Center
World Health Organization