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Original research
Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review
  1. Julie Jepsen Strøm1,
  2. Pia Sperling Haugen1,
  3. Malene Plejdrup Hansen1,
  4. Ole Graumann2,3,
  5. Martin Bach B Jensen1,
  6. Camilla Aakjær Andersen1
  1. 1Center for General Practice at Aalborg University, Aalborg, Denmark
  2. 2Department of Radiology, Odense Universitetshospital, Odense, Denmark
  3. 3Institute for Clinical Research, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
  1. Correspondence to Dr Julie Jepsen Strøm; jrjepsen{at}


Objectives We aimed to systematically review the published literature regarding adults with clinical suspicion of pneumonia that compares the accuracy of lung ultrasonography (LUS) performed by non-imaging specialists to other reference standards in diagnosing and evaluating the severity of community-acquired pneumonia. Moreover, we aimed to describe LUS training and the speciality of the physician performing LUS, time spent on the LUS procedure and potential harms to patients.

Materials and methods We searched MEDLINE, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials up until May 2019. We included studies that used LUS to diagnose pneumonia, but also confirmed pneumonia by other means. Publications were excluded if LUS was performed by a sonographer or radiologist (imaging specialists) or performed on other indications than suspicion of pneumonia. Two review authors screened and selected articles, extracted data and assessed quality using Quality Assessment of Diagnostic Accuracy Studies 2.

Results We included 17 studies. The sensitivity of LUS to diagnose pneumonia ranged from 0.68 to 1.00; however, in 14 studies, sensitivity was ≥0.91. Specificities varied from 0.57 to 1.00. We found no obvious differences between studies with low and high diagnostic accuracy. The non-imaging specialists were emergency physicians, internal medicine physicians, intensivists or ‘speciality not described’. Five studies described LUS training, which varied from a 1-hour course to fully credentialed ultrasound education. In general, the methodological quality of studies was good, though, some studies had a high risk of bias.

Conclusion We found significant heterogeneity across studies. In the majority of studies, LUS in the hands of the non-imaging specialists demonstrated high sensitivities and specificities in diagnosing pneumonia. However, due to problems with methodology and heterogeneity there is a need for larger studies with uniform and clearly established criteria for diagnosis and blinding.

PROSPERO registration number Prospectively registered in PROSPERO (CRD42017057804).

  • ultrasonography
  • respiratory infections
  • general medicine (see internal medicine)
  • primary care

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  • Contributors JJS is the guarantor of the study. JJS, PSH, MPH, MBBJ, OG and CAA contributed to the concept, design and drafting of the study. JJS, PSH and MPH conducted the systematic search strategy and the review. All authors revised critically and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.