title: The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review.
abstract: OBJECTIVE
  (1) Summarise chest ultrasound accuracy to diagnose radiological consolidation, referenced to chest CT in patients with acute respiratory failure (ARF). (2) Directly compared ultrasound with chest X-ray.
  
  
  METHODS
  Hospitalised patients.
  
  
  METHODS
  Studies were eligible if adult participants in respiratory failure underwent chest ultrasound to diagnose consolidation referenced to CT. Exclusion: (1) not primary study, (2) not respiratory failure, (3) not chest ultrasound, (4) not consolidation, (5) translation unobtainable, (6) unable to extract data, (7) unable to obtain paper. 4 studies comprising 224 participants met inclusion.
  
  
  METHODS
  As planned, paired forest plots display 95% CIs of sensitivity and specificity for ultrasound and chest X-ray. Sensitivity and specificity from each study are plotted in receiver operator characteristics space. Meta-analysis was planned if studies were sufficiently homogeneous and numerous (≥4). Although this numerical requirement was met, meta-analysis was prevented by heterogeneous units of analysis between studies.
  
  
  RESULTS
  All studies were in intensive care, with either a high risk of selection bias or high applicability concerns. Studies had unclear or high risk of bias related to use of ultrasound. Only 1 study clearly performed ultrasound within 24 h of respiratory failure diagnosis. Ultrasound sensitivity ranged from 0.91 (95% CI 0.81 to 0.97) to 1.00 (95% CI 0.95 to 1.00). Specificity ranged from 0.78 (95% CI 0.52 to 0.94) to 1.00 (0.99 to 1.00). In two studies, chest X-ray had lower sensitivity than ultrasound, but there were insufficient patients to compare specificity.
  
  
  CONCLUSIONS
  Four small studies suggest ultrasound is highly sensitive and specific for consolidation in ARF, but high risk of bias and concerns about applicability in all studies may have inflated diagnostic accuracy. Further robustly designed studies are needed to define the role of ultrasound in this setting.
  
  
  BACKGROUND
  http://www.crd.york.ac.uk/PROSPERO/ (CRD42013006472).
authors.affiliation: Department of Allergy Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hew
authors.affiliation: Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Corcoran
authors.affiliation: Bodleian Health Care Libraries, University of Oxford, Oxford, UK.
authors.forename: Elinor K
authors.initials: EK
authors.lastname: Harriss
authors.affiliation: Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
authors.forename: Najib M
authors.initials: NM
authors.lastname: Rahman
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Mallett
mesh_terms: D003422:Critical Care / Q000379:methods / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000000981:diagnostic imaging*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013909:Thorax / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography