SERAFINO MANSUETO AWARD | Bedside lung ultrasound in the diagnosis of community acquired pneumonia in 569 elderly patients in an Internal Medicine department
F. Giangregorio1, F. Tursi2, M.G. Debellis1, E. Mosconi1, S. Provini1, F. Bruno1, G. Archenti1, L. Balzarini3, C. Mancini3, M. Marvisi3 | 1Medicina Interna, Ospedale di Codogno (LO); 2Riabilitazione Cardiovascolare; Ospedale di Codogno (LO); 3Medicina Interna, Casa di Cura Figlie di San Camillo, Cremona, Italy
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Premises and Purpose of the study: Aim of the study is to evaluate the clinical performance and utility of Bedside Lung ultrasound in diagnosis of community acquired pneumonia (CAP) in elderly patients.
Materials and Methods: 569 patients were studied from January 2021 to 2025; final diagnosis: 77 acute bronchitis/COPD (mean age: 79,1Y); pneumonia: 492 (mean age: 79,4Y); Clinical Diagnosis (CD) (based on patient history, physical examination and laboratory tests), chest x-ray (CXR) and lung ultrasound (LUS) were evaluated. Corresponding Sensitivity, specificity, overall diagnostic accuracy (ODA) (and AUROC) of were calculated.
Results: CD: True+: 135; true-: 59; False+: 18; False-: 357 (SENS: 27%; SPEC: 76,6%; ODA: 9,3% PPV: 88,2% NPV: 14,2%) (AU-ROC: 0,5203 SEAUC=0,035); CXR: True+: 244; true-:43; False-: 34; False-: 248 (SENS: 49,6; SPEC: 55,8%; ODA: 17%; PPV: 87,8%; NPV: 14,8%) (AU-ROC: 0,5272 SEAUC=0,0349); LUS: True+: 464; True-: 58; False+: 19; False-: 28 (SENS: 94,3%; SPEC: 75,3%; ODA: 90,9%; PPV: 96,1%; NPV: 67,4%) (AU-ROC: 0,8175 SEAUC=0,0202); pneumonia was diagnosed: by CRX and LUS in 129/492 (26,21%); only by LUS in 335/492 (68%) (in 28/335 -8,3%- Pneumonia diagnosis was clinically unexpected); only by CT in 28/492 (5,6%) cases.
Conclusions: CD of CAP in the elderly is difficult and unsatisfactory; the radiological one is obtainable in about half of the cases; Bedside Lus diagnoses pneumonia correctly in 94.3% (and alone in 68%) of elderly people; It has excellent sensitivity (94.3%) but a non -optimal specificity (75.3%); In 8% of cases CAP diagnosis was unexpected.
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