Sensitivity, specificity and diagnostic accuracy of novices integrating lung ultrasound into the care of breathless older patients

Baker, Kylie, Soong, Luke, Harding, Timothy, Wain, Amy, Cheah, Jon, Mitchell, Geoffrey and Brierley, Stephen (2015) Sensitivity, specificity and diagnostic accuracy of novices integrating lung ultrasound into the care of breathless older patients. Australasian Journal of Ultrasound in Medicine, 18 4: 143-145. doi:10.1002/j.2205-0140.2015.tb00221.x


Author Baker, Kylie
Soong, Luke
Harding, Timothy
Wain, Amy
Cheah, Jon
Mitchell, Geoffrey
Brierley, Stephen
Title Sensitivity, specificity and diagnostic accuracy of novices integrating lung ultrasound into the care of breathless older patients
Journal name Australasian Journal of Ultrasound in Medicine
ISSN 1836-6864
2205-0140
Publication date 2015-11-01
Sub-type Article (original research)
DOI 10.1002/j.2205-0140.2015.tb00221.x
Open Access Status Not yet assessed
Volume 18
Issue 4
Start page 143
End page 145
Total pages 3
Place of publication Richmond, VIC, Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2016
Language eng
Formatted abstract
Background:  Lung ultrasound is frequently used to identify pulmonary oedema, using the ‘B line’ artefact. A small study in 2011 suggested that novice sonologists had a potential diagnostic accuracy of 85%, when performing the test without reference to other patient information.

Aim:  We aimed to test the overall diagnostic accuracy of novice clinician sonologists incorporating the 2011 protocol into routine assessment of the patient.

Method:  A prospective convenience sample of breathless older patients presenting to ED received an 8-view lung scan early in management. Initial ED diagnoses, utilising all information including ultrasound result, were compared against the opinion of a medical expert auditing the patient records after discharge from hospital.

Results:  The cohort of five novices scanned 63 cases, from which eleven were excluded.

Novices using ultrasound differentiated between pulmonary oedema and other causes of breathlessness with a sensitivity of 71% (95%CI 44 to 87), Specificity of 91% (76 to 98), a diagnostic accuracy of 85% (72 to 92), a positive LR of 8.2 (2.7 to 25) and a negative LR of 0.32 (0.15 to 0.68).

Discussion:  The diagnostic accuracy of emergency department clinicians incorporating novice lung ultrasound into the investigation of breathlessness is consistent with the diagnostic accuracy of scanning performed in parallel to patient care, and is likely to be an improvement on current estimates of conventional ED diagnostic strategies. Clinicians should not be afraid that their learning curve would disadvantage the patient.
Keyword Diagnostic accuracy
Heart failure
Lung ultrasound
Novice
Q-Index Code CX
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
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Created: Mon, 07 Mar 2016, 22:31:19 EST by Mrs Carolyn Hinds-Edwards on behalf of Sustainable Minerals Institute