title: Diagnostic Accuracy of Central Venous Catheter Confirmation by Bedside Ultrasound Versus Chest Radiography in Critically Ill Patients: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  We performed a systematic review and meta-analysis to examine the accuracy of bedside ultrasound for confirmation of central venous catheter position and exclusion of pneumothorax compared with chest radiography.
  
  
  METHODS
  PubMed, Embase, Cochrane Central Register of Controlled Trials, reference lists, conference proceedings and ClinicalTrials.gov.
  
  
  METHODS
  Articles and abstracts describing the diagnostic accuracy of bedside ultrasound compared with chest radiography for confirmation of central venous catheters in sufficient detail to reconstruct 2 × 2 contingency tables were reviewed. Primary outcomes included the accuracy of confirming catheter positioning and detecting a pneumothorax. Secondary outcomes included feasibility, interrater reliability, and efficiency to complete bedside ultrasound confirmation of central venous catheter position.
  
  
  METHODS
  Investigators abstracted study details including research design and sonographic imaging technique to detect catheter malposition and procedure-related pneumothorax. Diagnostic accuracy measures included pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio.
  
  
  RESULTS
  Fifteen studies with 1,553 central venous catheter placements were identified with a pooled sensitivity and specificity of catheter malposition by ultrasound of 0.82 (0.77-0.86) and 0.98 (0.97-0.99), respectively. The pooled positive and negative likelihood ratios of catheter malposition by ultrasound were 31.12 (14.72-65.78) and 0.25 (0.13-0.47). The sensitivity and specificity of ultrasound for pneumothorax detection was nearly 100% in the participating studies. Bedside ultrasound reduced mean central venous catheter confirmation time by 58.3 minutes. Risk of bias and clinical heterogeneity in the studies were high.
  
  
  CONCLUSIONS
  Bedside ultrasound is faster than radiography at identifying pneumothorax after central venous catheter insertion. When a central venous catheter malposition exists, bedside ultrasound will identify four out of every five earlier than chest radiography.
authors.affiliation: 1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.2Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO.3Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI.4Bernard Becker Medical Library, Washington University School of Medicine, St. Louis, MO.
authors.forename: Enyo A
authors.initials: EA
authors.lastname: Ablordeppey
authors.forename: Anne M
authors.initials: AM
authors.lastname: Drewry
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Beyer
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Theodoro
authors.forename: Susan A
authors.initials: SA
authors.lastname: Fowler
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Carpenter
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects; D016638:Critical Illness; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D019095:Point-of-Care Systems; D013902:Radiography, Thoracic; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D014463:Ultrasonography