Acil servise pnömoni şüphesi ile başvuran hastalarda akciğer ultrasonunun tanısal ve prognostik etkinliğinin değerlendirilmesi
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç
Acil servise başvuran ve pnömoni şüpheli bulguları olan hastalarda, akciğer ultrasonografisinin tanısal ve prognostik değerliliğinin araştırılması amaçlandı.
Materyal ve Metod
Prospektif ve metodolojik nitelikte dizayn edilen çalışmada, Ege Üniversitesi Tıp Fakültesi Acil Servisi’ne 20 Şubat-20 Mayıs 2020 tarihleri arasında pnömoni şüphesi ile başvuran 18 yaş üstü 330 hasta akciğer ultrasonu ile değerlendirilmiştir. Ultrason ile elde edilen bulgular toplanmış ve veriler çalışma formu aracılığıyla kaydedilmiştir.
Bulgular
Çalışmaya dahil edilen hastaların tamamına akciğer ultrasonu yapılmış ve tamamına akciğer grafisi çekilmiştir. Hastaların %63,6’sına klinik izlemi sırasında toraks bilgisayarlı tomografisi çekilmiştir. Hastaların %68,2’sinde ultrasonografik olarak pnömoni saptanmıştır. Hastaların %70’inin klinik son tanısının pnömoni olduğu saptanmıştır. Hastaların %32,7’si acil servisten taburcu olurken, %37,0’sine servis yatışı, %29,1’ine ise yoğun bakım yatışı gerçekleştirilmiştir. Hastaların hastaneye başvuruyu takip eden bir ay içerisinde mortalite oranı ise %25,5’dir.
Pnömoni son tanılı hastalarda ultrason bulguları incelendiğinde ise en yaygın bulguların sırası ile konsolidasyon (%93,1), B çizgilerinin varlığı (%68,4), shred bulgusu (%64,9) ve plevral düzensizlik (%59,7) olduğu saptanmıştır. Sırasıyla diğer bulgular vaskülaritede artış (%48,1), hava ve sıvı bronkogramları (%46,3), dinamik hava bronkogramları (%37,7), plevral efüzyon (%19,9), vertebra bulgusu (%14,3), jellyfish bulgusu (%8,2), plankton bulgusu (%3,9) olarak saptanmıştır. Yaş gruplarına göre ultrason bulgularının dağılımı incelendiğinde yalnızca plevral düzensizlik (p=0.002) bulgusunda istatistiksel açıdan anlamlı fark saptanmıştır.
Ultrasonografinin pnömoni tanısı için duyarlılığı %96,5 özgüllüğü ise %98,0 olarak saptanmıştır. Akciğer grafisinin pnömoni tanısı için duyarlılığı %82,7 ve özgüllüğü %92,9 olarak saptanmıştır. Bilgisayarlı tomografi çekilen 210 hastada ultrasonografinin pnömoni tanısı için duyarlılığı %96,9 özgüllüğü ise %95,8 olarak, akciğer grafisinin duyarlılığı %77,2 ve özgüllüğü %85,4 olarak saptanmıştır.
Ultrason bulgularının pnömoni tanısında duyarlılık ve özgüllükleri sırasıyla bakıldığında shred bulgusu için %64,9 - %99,0, hava ve sıvı bronkogramı için %46,3 - %100, dinamik hava bronkogramı için %37,7 - %100, konsolidasyon için %93,1 - %94,9, vaskülarite artışı için %48,1 - %98,0, B çizgileri için %68,4 - %53,5, plevral efüzyon için %19,9 - %85,9, plevral düzensizlik için %59,7 - %75,8, vertebra bulgusu için %14,3 - %98,0, jellyfish bulgusu için %8,2 - %99,0, plankton bulgusu için %3,9 - %100 olarak izlenmiştir.
Son tanısı pnömoni olan hastalarda ultrason bulgularıyla bir aylık mortalite arasındaki ilişki değerlendirildiğinde hava sıvı bronkogramları (p=0.042) ve plevral düzensizlik (p<0.001) ile bir aylık mortalite arasında istatistiksel açıdan anlamlı ilişki saptanmıştır. Mortalite üzerine en yüksek risk oluşturan bulguların plevral düzensizlik (OR: 4.462, %95; 2.268-8.776) ve hava sıvı bronkogramları (OR: 1.791, %95; 1.019-3.149) olduğu görülmüştür.
Klinik son tanısı pnömoni olan hastalarda ultrason bulgularının Pnömoni Ağırlık Skoru ile ilişkisi değerlendirildiğinde konsolidasyon (p=0.004), plevral efüzyon (p=0.005) ve plevral düzensizlik (p<0.001) bulgularının varlığında Pnömoni Ağırlık Skoru’nun daha yüksek olduğu gözlemlenmiştir. Klinik son tanısı pnömoni olan hastalarda ultrason bulgularının CURB-65 ile ilişkisi değerlendirildiğinde konsolidasyon (p=0.025), plevral efüzyon (p=0.035) ve plevral düzensizlik (p<0.001) bulgularının varlığında CURB-65 skorunun daha yüksek olduğu gözlemlenmiştir.
Sonuç
Akciğer ultrasonu, pnömoni tanısı koymada akciğer grafisine göre duyarlılığı ve özgüllüğü yüksek bir incelemedir. Akciğer ultrasonu, toplumda gelişen pnömoni tanısında akciğer grafisinin ayırt edemediği hastalarda yol gösterici olabilir ve gereksiz bilgisayarlı tomografi çekiminin önüne geçmek için kullanılabilecek bir yöntemdir.
Akciğer ultrasonu noninvaziv, taşınabilir ve radyasyon barındırmayan bir tetkik olması nedeni ile tekrarlayan görüntülemeye imkan sağlar ve izlemde kullanılabilir. Akciğer ultrasonu pnömoni tanılı hastalarda prognostik bir gösterge olabilir.
Aim It was aimed to investigate the diagnostic and prognostic value of lung ultrasonography in patients admitted to the emergency department with suspicious findings of pneumonia. Material and Method The study was designed as a prospective and methodological study. 330 patients aged 18 and over who were admitted to Ege University Faculty of Medicine Emergency Department between February 20 and May 20, 2020 with suspected pneumonia were evaluated by lung ultrasound. Results Lung ultrasound was performed in all patients included in the study, and chest radiography was obtained for all patients. Computed tomography of the thorax was obtained in 63.6% of the patients during clinical follow-up. Pneumonia was detected ultrasonographically in 68.2% of the patients. It was found that the final clinical diagnosis of 70% of the patients was pneumonia. While 32.7% of the patients were discharged from the emergency service, 37.0% were hospitalized in the service and 29.1% were hospitalized in intensive care unit. The mortality rate is 25.5% within one month following the admission to the hospital. The ultrasound findings were examined in patients with the last diagnosis of pneumonia. It was found that the most common findings were consolidation (93.1%), presence of B lines (68.4%), shred sign (64.9%), and pleural irregularity (59.7%), respectively. Other findings, respectively, increase in vascularity (48.1%), air and fluid bronchograms (46.3%), dynamic air bronchograms (37.7%), pleural effusion (19.9%), spine sign (14.3%), jellyfish sign (8.2%), plankton sign (3.9%). The difference of ultrasound findings by age groups was examined, and a statistically significant difference was found only in the finding of pleural irregularity (p = 0.002). The sensitivity of ultrasonography for the diagnosis of pneumonia was 96.5% and the specificity was 98.0%. The sensitivity of chest radiography for the diagnosis of pneumonia was 82.7% and specificity was 92.9%. In 210 patients who underwent computed tomography, the sensitivity of ultrasonography for the diagnosis of pneumonia was 96.9%, specificity was 95.8%, and the sensitivity of chest radiograph was 77.2% and specificity was 85.4%. When the sensitivity and specificities of ultrasound findings in the diagnosis of pneumonia are examined, respectively, 64.9% - 99.0% for shred finding, 46.3% - 100% for air and fluid bronchogram, 37.7% - 100% for dynamic air bronchogram,% for consolidation 93.1-94.9%, for increased vascularity 48.1% - 98.0%, for B lines 68.4% - 53.5%, for pleural effusion 19.9% - 85.9%, pleural irregularity 59.7% - 75.8% for spine sign, 8.2% - 99.0% for jellyfish sign, 3.9% - 100% for plankton sign. The correlation between ultrasound findings and one-month mortality in patients with the last diagnosis of pneumonia was evaluated. A statistically significant relationship was found between air-fluid bronchograms (p = 0.042) and pleural irregularity (p <0.001) and one-month mortality. The findings that pose the highest risk of mortality were pleural irregularity (OR: 4.462, 95%; 2.268-8.776) and air-fluid bronchograms (OR: 1.791, 95%; 1.019-3.149). Ultrasound findings and Pneumonia Severity Index were compared in patients with the last diagnosis of pneumonia. Pneumonia Severity Index was observed to be higher in the presence of consolidation (p = 0.004), pleural effusion (p = 0.005) and pleural irregularity (p <0.001). CURB-65 score was compared with ultrasound findings in patients with the last diagnosis of pneumonia. It was observed that the CURB-65 score was higher in the presence of consolidation (p = 0.025), pleural effusion (p = 0.035) and pleural disorder (p <0.001). Conclusion Lung ultrasound is an examination with high sensitivity and specificity compared to chest radiography in the diagnosis of pneumonia. Lung ultrasound can be a guide in the diagnosis of pneumonia in patients who cannot be distinguished by chest radiography, and it is a method that can be used to avoid unnecessary computed tomography. Since lung ultrasound is a noninvasive, portable, and radiation-free examination, it allows for repeated imaging and can be used in the follow-up. Lung ultrasound may be a prognostic indicator in patients diagnosed with pneumonia.
Aim It was aimed to investigate the diagnostic and prognostic value of lung ultrasonography in patients admitted to the emergency department with suspicious findings of pneumonia. Material and Method The study was designed as a prospective and methodological study. 330 patients aged 18 and over who were admitted to Ege University Faculty of Medicine Emergency Department between February 20 and May 20, 2020 with suspected pneumonia were evaluated by lung ultrasound. Results Lung ultrasound was performed in all patients included in the study, and chest radiography was obtained for all patients. Computed tomography of the thorax was obtained in 63.6% of the patients during clinical follow-up. Pneumonia was detected ultrasonographically in 68.2% of the patients. It was found that the final clinical diagnosis of 70% of the patients was pneumonia. While 32.7% of the patients were discharged from the emergency service, 37.0% were hospitalized in the service and 29.1% were hospitalized in intensive care unit. The mortality rate is 25.5% within one month following the admission to the hospital. The ultrasound findings were examined in patients with the last diagnosis of pneumonia. It was found that the most common findings were consolidation (93.1%), presence of B lines (68.4%), shred sign (64.9%), and pleural irregularity (59.7%), respectively. Other findings, respectively, increase in vascularity (48.1%), air and fluid bronchograms (46.3%), dynamic air bronchograms (37.7%), pleural effusion (19.9%), spine sign (14.3%), jellyfish sign (8.2%), plankton sign (3.9%). The difference of ultrasound findings by age groups was examined, and a statistically significant difference was found only in the finding of pleural irregularity (p = 0.002). The sensitivity of ultrasonography for the diagnosis of pneumonia was 96.5% and the specificity was 98.0%. The sensitivity of chest radiography for the diagnosis of pneumonia was 82.7% and specificity was 92.9%. In 210 patients who underwent computed tomography, the sensitivity of ultrasonography for the diagnosis of pneumonia was 96.9%, specificity was 95.8%, and the sensitivity of chest radiograph was 77.2% and specificity was 85.4%. When the sensitivity and specificities of ultrasound findings in the diagnosis of pneumonia are examined, respectively, 64.9% - 99.0% for shred finding, 46.3% - 100% for air and fluid bronchogram, 37.7% - 100% for dynamic air bronchogram,% for consolidation 93.1-94.9%, for increased vascularity 48.1% - 98.0%, for B lines 68.4% - 53.5%, for pleural effusion 19.9% - 85.9%, pleural irregularity 59.7% - 75.8% for spine sign, 8.2% - 99.0% for jellyfish sign, 3.9% - 100% for plankton sign. The correlation between ultrasound findings and one-month mortality in patients with the last diagnosis of pneumonia was evaluated. A statistically significant relationship was found between air-fluid bronchograms (p = 0.042) and pleural irregularity (p <0.001) and one-month mortality. The findings that pose the highest risk of mortality were pleural irregularity (OR: 4.462, 95%; 2.268-8.776) and air-fluid bronchograms (OR: 1.791, 95%; 1.019-3.149). Ultrasound findings and Pneumonia Severity Index were compared in patients with the last diagnosis of pneumonia. Pneumonia Severity Index was observed to be higher in the presence of consolidation (p = 0.004), pleural effusion (p = 0.005) and pleural irregularity (p <0.001). CURB-65 score was compared with ultrasound findings in patients with the last diagnosis of pneumonia. It was observed that the CURB-65 score was higher in the presence of consolidation (p = 0.025), pleural effusion (p = 0.035) and pleural disorder (p <0.001). Conclusion Lung ultrasound is an examination with high sensitivity and specificity compared to chest radiography in the diagnosis of pneumonia. Lung ultrasound can be a guide in the diagnosis of pneumonia in patients who cannot be distinguished by chest radiography, and it is a method that can be used to avoid unnecessary computed tomography. Since lung ultrasound is a noninvasive, portable, and radiation-free examination, it allows for repeated imaging and can be used in the follow-up. Lung ultrasound may be a prognostic indicator in patients diagnosed with pneumonia.
Açıklama
Anahtar Kelimeler
Pnömoni, Ultrasonografi, Mortalite, Pneumonia, Ultrsonography, Mortality
