2021 Volume 48 Issue 2 Pages 91-99
Purpose: The incidence of pneumonia is increasing with the increase in the elderly population. Although lung ultrasonography can be useful to diagnose pneumonia, there are not enough studies on the diagnostic accuracy of Lung point-of-care ultrasound (LPOCUS) in the elderly. The aim of the present study is to evaluate the diagnostic accuracy of LUS with a mobile US scanner for pneumonia in elderly patients. Method: Subjects were 101 elderly patients(mean age 87.1 years, 57 males) admitted to our hospital with suspected pneumonia between January 1 and December 31, 2019. LPOCUS was performed using a mobile ultrasound scanner, and the results were compared with those of diagnosis by blood test, chest X-ray, and chest CT. Diagnosis of pneumonia by LPOCUS was defined as multiple Blines(mBline) or consolidation. Diagnosis of heart failure required mBline in two areas or more on both sides, and presence of one or more of the following: IVC diameter 2 cm≤, respiratory variation ≤50%, ratio of right ventricle to left ventricle 1≤, and bilateral pleural effusion. Results: Of the 101 cases, 72 cases were comprehensively diagnosed with pneumonia, eight cases with heart failure with pneumonia, and seven cases with heart failure. Using LPOCUS, 75 cases were diagnosed with pneumonia and 12 cases with heart failure. The concordance rate between diagnosis by LPOCUS and clinical diagnosis was 87% (κ＝0.601, p<0.0001), which was good. The sensitivity of diagnosis of pneumonia was 99% for CT, 92% for X-ray, and 89% for LPOCUS. Specificity was highest for CT (85%), while LPOCUS and X-ray were 78%. The positive predictive value was 96% for CT, 95% for LPOCUS, and 93% for CXR, and the negative predictive value was 94% for CT, 74% for CXR, and 61% for LPOCUS. Conclusion: Bedside LPOCUS with a mobile US scanner was extremely useful for the diagnosis of pneumonia in the elderly.
