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Bedside lung ultrasonography: comparison with chest radiography (BLUR), a diagnostic study in a developing country
  1. Manisha Arthur1,2,
  2. Kishore Pichamuthu3,
  3. Vijay Prakash Turaka2,
  4. Tharani Putta4,
  5. Mohammad Sadiq Jeeyavudeen2,
  6. Anand Zachariah2,
  7. Sowmya Sathyendra2,
  8. Samuel George Hansdak2,
  9. Ramya Iyadurai2,
  10. Reka Karuppusami5,
  11. Thambu David Sudarsanam2
  1. 1Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu, India
  2. 2Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamilnadu, India
  3. 3Department of Critical Care, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  4. 4Department of Radiology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  5. 5Department of Biostatistics, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Manisha Arthur, Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamilnadu 600116, India; manisha_arthur{at}yahoo.co.in

Abstract

Background This study determines the diagnostic utility of lung ultrasonography (LUS) in a medical ward in a developing country. In a low resource country like India, we hope that use of lung ultrasound in primary and secondary hospitals will assist in earlier and better bedside diagnosis.

Methods This prospective diagnostic study was done to test the diagnostic accuracy of LUS against a composite reference standard, which included clinical history and examination, basic laboratory investigations, imaging and the diagnosis at discharge. We evaluated 321 consecutive patients, admitted in our medical wards with an LUS within 24 hours of the chest radiograph being done.

Findings Between August 2016 and August 2017, we enrolled 321 patients. The sensitivity and specificity of the LUS for all pathologies were found to be 82.5% (76.50 to 87.20) and 78.2% (69.09 to 85.26) respectively. A subgroup analysis including the patients in whom CT was part of the composite reference standard showed sensitivity and specificity of 87.9% and 92.9% for all lung pathologies. It was found that there was superior sensitivity and specificity of LUS compared with chest radiograph in a subgroup analysis of pulmonary oedema and acute respiratory distress syndrome (ARDS).

Interpretation We found that the LUS was better than chest radiograph and as good as CT in most pathologies, especially pulmonary oedema and ARDS. We believe that training in the basics of bedside LUS must be part of the medical curriculum and a low-cost ultrasound machine must be made available in medical wards, so that clinical diagnosis can be supplemented with this tool. In a low resource setting like India, where access to chest radiograph and CT may be difficult particularly in a rural setup, expertise in LUS would be helpful in easy bedside diagnosis and saving cost on a CT scan.

  • GENERAL MEDICINE
  • Thoracic medicine
  • Diagnostic radiology
  • Ultrasound

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Contributors MA: research and study design, data collection and analysis, interpretation and conclusion, preparation of manuscript, review of manuscript. KP: research and study design, data collection and analysis, interpretation and conclusion, preparation of manuscript, review of manuscript, critical revision. VPT: research and study design, data collection and analysis, interpretation and conclusion, review of manuscript. TP: research and study design, data collection and analysis, review of manuscript. MS: research and study design, data collection and analysis, review of manuscript. AZ: research and study design, data collection and analysis, review of manuscript. SS: research and study design, data collection and analysis, review of manuscript. SGH: research and study design, data collection and analysis, review of manuscript. RI: research and study design, data collection and analysis, review of manuscript. RK: research and study design, data collection and analysis, interpretation and conclusion. TDS: research and study design, data collection and analysis, interpretation and conclusion, preparation of manuscript, review of manuscript, critical revision. MA, KP and TDS have verified the underlying data. MA and TDS are the guarantors for the study.

  • Funding The protocol was approved by the institutional review board (IRB) of Christian Medical College, Vellore and the funding was provided by the FLUID grant of the IRB. There was no involvement of the funding source in study design, in the collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.