1. Comparing Accuracy of Ultrasound to Chest X-ray in Determining Pulmonary Edema
Matt Wooten, DO
PGY 2
5/4/2017

2. Background
Pulmonary edema is an abnormal increase in extravascular water in the pulmonary circulation
CHF is the most common cause of hospitalization in the Medicare population; greater than $8,000 per person per year, with cost of admissions greater than $12,000
High re-admission rates due to CHF exacerbations
Chest x-ray (CXR) has traditionally been the preferred imaging study to assess CHF
However, interpretation of characteristic radiologic signs are often very subjective
Lung ultrasound (US) produces more objective findings by the evaluation of vertical comet tail artifacts named B-lines
Little research directly comparing US to CXR in the evaluation of pulmonary edema in patients with CHF
©2016 Trinity Health - Livonia, Mich.

3. Objective
Demonstrate that US is more effective at detecting pulmonary edema than CXR
©2016 Trinity Health - Livonia, Mich.

4. Research Question
What are the sensitivity, specificity and predictive values of US compared to CXR for detection of pulmonary edema, using the discharge summary as the reference standard?
What is the rate of agreement between the two exams?
©2016 Trinity Health - Livonia, Mich.

5. Population Patients aged ≥18
Presented to the Mount Carmel West (MCW) Emergency Department with dyspnea
Received CXR
©2016 Trinity Health - Livonia, Mich.

6. Methods Prospective, proceduralist- and assessor-blinded trial
US was performed on both sides of the chest in four locations
Positive scan for pulmonary edema was defined by a minimum of 3 B-lines in at least two areas on each side of the chest
US was not documented in the patient's chart or used to determine the patient's diagnosis or course of treatment
Comments on radiologist reports of CXRs such as “pulmonary vascular congestion” and “bilateral interstitial infiltrates" identified findings suggestive of pulmonary edema
Sensitivity and specificity were calculated using the diagnosis of pulmonary edema as the reference standard specified in the patient's discharge summary
©2016 Trinity Health - Livonia, Mich.

7. ©2016 Trinity Health - Livonia, Mich.

8. Outcomes 99 patients, mostly late 60's 77% were obese
US and CXR had an agreement rate of 76.8%
However, US was more likely to detect and rule out pulmonary edema than CXR
When comparing to the discharge summary, sensitivity of US was significantly higher at 96.1% versus 64.7% for CXR
Specificity was only slightly higher for CXR at 95.8% versus 89.6% for US
Negative predictive value was also significantly higher for US at 95.6% versus 71.9% for CXR
Positive predictive value was only slightly higher for CXR at 94.3% versus 90.7% for US
US was right in 18.2% of cases when the CXR was wrong
CXR was right in 5.1% when US was wrong
©2016 Trinity Health - Livonia, Mich.

9. Significance
As more practitioners are trained in bedside US, it can be regularly utilized in clinical practice
If these findings are confirmed, this should lead to lower costs and less radiation exposure to patients in the future
©2016 Trinity Health - Livonia, Mich.

10. Contact Information
Matt Wooten, DO PGY 2 Internal Medicine Mount Carmel West Hospital Columbus, OH Chief Resident-Elect
©2016 Trinity Health - Livonia, Mich.