胸部X线摄影(CXR)通常用于诊断儿童肺炎,但对辐射暴露的担忧引起了人们对使用无辐射肺超声(LUS)作为替代成像模式的兴趣.因此,我们设计了这项荟萃分析,以比较LUS和CXR诊断儿童肺炎的准确性.我们搜索了8个数据库和1个临床试验注册中心,以查找从开始到2023年3月发表的研究。包括评估肺部超声和胸部X线摄影术以诊断儿童肺炎的研究。两名审稿人独立筛选文献,提取的数据,并使用QUADAS-2工具评估各项研究的偏倚风险。Meta分析采用随机效应模型,和汇集的敏感性,特异性,正似然比,负似然比,诊断赔率比,并对受试者工作特征(SROC)曲线进行评估。使用Meta-Disc1.4,RevMan5.4和Stata17.0软件进行统计分析。检查了异质性,并进行亚组分析,探讨肺部超声诊断儿童肺炎的准确性。在4089篇筛选的文章中,包括30项研究,共包括4546名儿童。其中,3257人被诊断为肺炎,3190通过LUS,和2925通过CXR。荟萃分析表明,特异性,正负似然比,LUS的诊断比值比为0.940(95%CI0.930-0.949),0.855(95%CI0.835-0.873),7.561(95%CI4.956-11.536),0.08(95%CI0.056-0.113),和110.77(95%CI62.156-197.40),分别。组合SROC曲线下面积为0.9712,Q指数=0.9218。对于CXR,灵敏度,特异性,正负似然比,诊断比值比为0.893(95%CI0.881-0.905),0.906(95%CI0.889-0.921),18.742(95%CI7.551-46.520),0.105(95%CI0.062-0.180),和237.43(95%CI74.080-760.99),分别。组合SROC曲线下面积为0.9810,Q指数=0.9391。亚组分析表明,实施地点,肺部超声和胸片之间的间隔,和操作经验对肺部超声诊断儿童肺炎的准确性没有影响。现有证据表明,肺部超声诊断儿童社区获得性肺炎具有很高的准确性。与胸部X线摄影相比,肺部超声具有更高的灵敏度,相似的特异性,和无辐射等优点,更低的成本,操作简单,和后续行动的便利性,使其成为诊断儿童肺炎的重要成像方式。
Chest radiography (CXR) is commonly used for diagnosing childhood pneumonia, but concerns about radiation exposure have raised interest in using radiation-free lung ultrasound (LUS) as an alternative imaging modality. Therefore, we designed this meta-analysis to compare the accuracy of LUS and CXR for diagnosing childhood pneumonia. We searched 8 databases and 1 clinical trial registry for studies published from inception to March 2023. Studies assessing lung ultrasound and chest radiography for diagnosing childhood pneumonia were included. Two reviewers independently screened literature, extracted data, and assessed the risk of bias using the QUADAS-2 tool for each study. Meta-analysis was conducted using a random-effects model, and pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic (SROC) curve were assessed. Statistical analyses were performed using Meta-Disc 1.4, RevMan 5.4, and Stata 17.0 software. Heterogeneity was examined, and subgroup analysis was conducted to explore the accuracy of lung ultrasound in diagnosing childhood pneumonia. Out of the 4089 screened articles, 30 studies were included, encompassing a total of 4546 children. Of those, 3257 were diagnosed with pneumonia, 3190 through LUS, and 2925 via CXR. The meta-analysis showed that the sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of LUS were 0.940 (95% CI 0.930-0.949), 0.855 (95% CI 0.835-0.873), 7.561 (95% CI 4.956-11.536), 0.08 (95% CI 0.056-0.113), and 110.77 (95% CI 62.156-197.40), respectively. The combined area under the SROC curve was 0.9712, Q index = 0.9218. For CXR, the sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.893 (95% CI 0.881-0.905), 0.906 (95% CI 0.889-0.921), 18.742 (95% CI 7.551-46.520), 0.105 (95% CI 0.062-0.180), and 237.43 (95% CI 74.080-760.99), respectively. The combined area under the SROC curve was 0.9810, Q index = 0.9391. Subgroup analysis showed that the implementation location, interval between lung ultrasound and chest radiography, and operator experience had no impact on the accuracy of lung ultrasound in diagnosing childhood pneumonia. Existing evidence suggests that lung ultrasound has high accuracy for diagnosing childhood community-acquired pneumonia. Compared with chest radiography, lung ultrasound has higher sensitivity, similar specificity, and advantages such as radiation-free, lower cost, simplicity of operation, and ease of follow-up, making it an important imaging modality for diagnosing childhood pneumonia.