Diagnosis of Pneumothorax by Radiography and Ultrasonography A Meta-analysis

Objective: This study compares, by meta-analysis, the use of anterior-posterior chest radiography (CR) with transthoracic ultrasonography for the diagnosis of pneumothorax. Methods: English-language articles on the performance of CR and ultrasonography in the diagnosis of a pneumothorax were selected. In eligible studies, data were recalculated, and the forest plots and summary receiver operating characteristic (sROC) curves were analyzed. Results: Pooled sensitivity and specificity were 0.88 and 0.99, respectively, for ultrasonography, and 0.52 and 1.00, respectively, for CR. For ultrasonography performed by clinicians other than radiologists, pooled sensitivity and specificity were 0.89 and 0.99, respectively. The sROC areas under the curve were compared, and no significant differences between ultrasonography and CR were found. Meta-regression analysis implied that the operator is strongly associated with accuracy (relative diagnostic OR, 0.21; 95% CI, 0.05-0.96; P = .0455). Conclusions: The meta-analysis indicated that bedside ultrasonography performed by clinicians had higher sensitivity and similar specificity compared with CR in the diagnosis of pneumothorax, but the accuracy of ultrasonography in the diagnosis of pneumothorax depended on the skill of the operators. CHEST 2011; 140(4):859-866