In the urgent setting of emergency care, the choice between bedside lung ultrasound (LUS) and chest X-ray (CXR) can significantly impact patient outcomes, particularly when diagnosing conditions such as pneumonia and other respiratory pathologies. Numerous studies indicate that LUS offers considerable advantages over traditional CXR in various aspects.
Firstly, LUS has been shown to possess superior diagnostic accuracy. For instance, a study by Annapurna et al. reveals that LUS demonstrated a sensitivity of 96% for detecting pneumonic consolidations compared to only 74% for CXR (Annapurna et al., 2020). Alkhayat and Alam‐Eldeen support this by stating that LUS offers a rapid diagnostic pathway that can often eliminate the need for additional imaging such as CT, thus avoiding radiation exposure, which is particularly important for vulnerable patient populations, including children and pregnant women (Alkhayat & Alam‐Eldeen, 2014).
In addition to accuracy, LUS also provides timely diagnosis, which is critical in emergencies. For example, research conducted in the postoperative context showed that LUS detected clinically relevant pulmonary complications earlier than CXR, allowing for timely intervention (Touw et al., 2018). Additionally, Rinaldi et al. reinforced that LUS proved to be a more effective diagnostic tool, as it can be performed directly at the bedside, ensuring immediate results that facilitate quicker clinical decision-making (Rinaldi et al., 2019).
Moreover, the practicality of LUS in emergency settings is underscored by its applicability to various conditions beyond pneumonia. Studies have demonstrated its efficacy in diagnosing pleural effusions and guiding thoracocentesis (Soni et al., 2015; Sikora et al., 2012). This versatility further solidifies LUS as an essential component of point-of-care diagnostics, enabling healthcare providers to tackle overlapping conditions without the delay that often accompanies traditional radiographic methods.
Nevertheless, it is important to acknowledge that while LUS has many benefits, certain limitations exist. For instance, factors such as subcutaneous emphysema and surgical dressings can obstruct the ultrasound waves, impacting the quality of the images obtained (Traslaviña et al., 2017). Additionally, although X-ray remains beneficial in specific scenarios like assessing complex thoracic injuries that may not be adequately visualized with ultrasound, it still provides essential diagnostic information, particularly in traumatic injuries (Damasy et al., 2023).
In conclusion, the evidence overwhelmingly suggests that bedside lung ultrasound provides a more reliable, faster, and safer alternative to chest X-ray in emergency settings, particularly for the diagnosis of pneumonia and related respiratory conditions. Its growing incorporation into emergency care protocols is indicative of a transformative shift towards maximizing patient safety and diagnostic efficiency.
References:
- Alkhayat, K. and Alam‐Eldeen, M. (2014). Value of chest ultrasound in diagnosis of community acquired pneumonia. Egyptian Journal of Chest Diseases and Tuberculosis, 63(4), 1047-1051.
https://doi.org/10.1016/j.ejcdt.2014.06.002
- Annapurna, S., Gupta, U., Boppanna, S., Dixit, V., & Mallula, B. (2020). Comparative study of lung ultrasonography and chest radiography in suspected cases of pneumonia in critically ill patients. International Journal of Radiology and Diagnostic Imaging, 3(1), 101-104.
https://doi.org/10.33545/26644436.2020.v3.i1b.61
- Damasy, M., Khan, A., Badheeb, A., & Shaigi, M. (2023). Spontaneous haemopneumothorax: a rare illness with unusual presentation and aetiology. Open Journal of Clinical and Medical Case Reports, 9(32).
https://doi.org/10.52768/2379-1039/2115
- Rinaldi, L., Milione, S., Fascione, M., Pafundi, P., Altruda, C., Caterino, M., … & Adinolfi, L. (2019). Relevance of lung ultrasound in the diagnostic algorithm of respiratory diseases in a real‐life setting: a multicentre prospective study. Respirology, 25(5), 535-542.
https://doi.org/10.1111/resp.13659
- Sikora, K., Perera, P., Mailhot, T., & Mandavia, D. (2012). Ultrasound for the detection of pleural effusions and guidance of the thoracentesis procedure. Isrn Emergency Medicine, 2012, 1-10.
https://doi.org/10.5402/2012/676524
- Soni, N., Franco, R., Velez, M., Schnobrich, D., Dancel, R., Restrepo, M., … & Mayo, P. (2015). Ultrasound in the diagnosis and management of pleural effusions. Journal of Hospital Medicine, 10(12), 811-816.
https://doi.org/10.1002/jhm.2434
- Touw, H., Parlevliet, K., Beerepoot, M., Schober, P., Vonk, A., Twisk, J., … & Tuinman, P. (2018). Lung ultrasound compared with chest x‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia, 73(8), 946-954.
https://doi.org/10.1111/anae.14243
- Traslaviña, J., Martínez, M., Olivera, M., & Balsalobre, R. (2017). Comparative study of transthoracic ultrasound and chest x-ray in the postoperative period of thoracic surgery. International Surgery Journal, 4(9), 2925.
https://doi.org/10.18203/2349-2902.isj20173872