title: Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Early detection of pneumothorax is critically important. Several studies have shown that chest ultrasonography (CUS) is a highly sensitive and specific tool. The present systematic review and meta-analysis was designed to evaluate the diagnostic accuracy of CUS and chest radiography (CXR) for detection of pneumothorax.
  
  
  METHODS
  The literature search was conducted using PubMed, EMBASE, Cochrane, CINAHL, SUMSearch, Trip databases, and review article references. Eligible articles were defined as diagnostic studies on patients suspected for pneumothorax who underwent chest computed tomography (CT) scan and those assessing the screening role of CUS and CXR.
  
  
  RESULTS
  The analysis showed the pooled sensitivity and specificity of CUS were 0.87 (95% CI: 0.81-0.92; I2= 88.89, P<0.001) and 0.99 (95% CI: 0.98-0.99; I2= 86.46, P<0.001), respectively. The pooled sensitivity and specificity of CXR were 0.46 (95% CI: 0.36-0.56; I2= 85.34, P<0.001) and 1.0 (95% CI: 0.99-1.0; I2= 79.67, P<0.001), respectively. The Meta regression showed that the sensitivity (0.88; 95% CI: 0.82 - 0.94) and specificity (0.99; 95% CI: 0.98 - 1.00) of ultrasound performed by the emergency physician was higher than by non-emergency physician. Non-trauma setting was associated with higher pooled sensitivity (0.90; 95% CI: 0.83 - 0.98) and lower specificity (0.97; 95% CI: 0.95 - 0.99).
  
  
  CONCLUSIONS
  The present meta-analysis showed that the diagnostic accuracy of CUS was higher than supine CXR for detection of pneumothorax. It seems that CUS is superior to CXR in detection of pneumothorax, even after adjusting for possible sources of heterogeneity.
authors: Trauma Research Center, Baqiyatallah University of Medial Sciences, Tehran, Iran.
authors: Ali
authors: A
authors: Ebrahimi
authors: Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mahmoud
authors: M
authors: Yousefifard
authors: Trauma Research Center, Baqiyatallah University of Medial Sciences, Tehran, Iran.
authors: Hossein
authors: H
authors: Mohammad Kazemi
authors: Trauma Research Center, Baqiyatallah University of Medial Sciences, Tehran, Iran.
authors: Hamid Reza
authors: HR
authors: Rasouli
authors: Department of Occupational Health Engineering, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors: Hadi
authors: H
authors: Asady
authors: Department of Emergency Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
authors: Ali
authors: A
authors: Moghadas Jafari
authors: Department of Epidemiology and Biostatistics, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors: Mostafa
authors: M
authors: Hosseini
keywords: Diagnostic tests; Pneumothorax; Radiography; Routine; Ultrasonography