Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts

Micah L A Heldeweg; Marry R Smit; Shelley R Kramer-Elliott; Mark E Haaksma; Jasper M Smit; Laura A Hagens; Nanon F L Heijnen; Annemijn H Jonkman; Frederique Paulus; Marcus J Schultz; Armand R J Girbes; Leo M A Heunks; Lieuwe D J Bos; Pieter R Tuinman

doi:10.1097/CCM.0000000000005620

Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts

Micah L A Heldeweg^*, Marry R Smit, Shelley R Kramer-Elliott, Mark E Haaksma, Jasper M Smit, Laura A Hagens, Nanon F L Heijnen, Annemijn H Jonkman, Frederique Paulus, Marcus J Schultz, Armand R J Girbes, Leo M A Heunks, Lieuwe D J Bos, Pieter R Tuinman

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population.

DESIGN: A prospective diagnostic accuracy study with derivation and validation cohorts.

SETTING: Three academic mixed ICUs in the Netherlands.

PATIENTS: Consecutive adult ICU patients that received a lung ultrasound examination.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULT: The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome (n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS (n = 29) from CPE (n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77-0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS (n = 98) from CPE (n = 24) with a sensitivity of 31% (95% CI, 21-40%) and a specificity of 100% (95% CI, 86-100%).

CONCLUSIONS: Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.

Original language	English
Pages (from-to)	1607-1617
Journal	Critical Care Medicine
Volume	50
Issue number	11
Early online date	22 Jul 2022
DOIs	https://doi.org/10.1097/CCM.0000000000005620
Publication status	Published - Nov 2022

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Heldeweg, M. L. A., Smit, M. R., Kramer-Elliott, S. R., Haaksma, M. E., Smit, J. M., Hagens, L. A., Heijnen, N. F. L., Jonkman, A. H., Paulus, F., Schultz, M. J., Girbes, A. R. J., Heunks, L. M. A., Bos, L. D. J., & Tuinman, P. R. (2022). Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts. Critical Care Medicine, 50(11), 1607-1617. https://doi.org/10.1097/CCM.0000000000005620

@article{84706ca111db49d7abbca14d5eabb9e9,

title = "Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts",

abstract = "OBJECTIVES: To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population.DESIGN: A prospective diagnostic accuracy study with derivation and validation cohorts.SETTING: Three academic mixed ICUs in the Netherlands.PATIENTS: Consecutive adult ICU patients that received a lung ultrasound examination.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULT: The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome (n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS (n = 29) from CPE (n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77-0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS (n = 98) from CPE (n = 24) with a sensitivity of 31% (95% CI, 21-40%) and a specificity of 100% (95% CI, 86-100%).CONCLUSIONS: Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.",

author = "Heldeweg, {Micah L A} and Smit, {Marry R} and Kramer-Elliott, {Shelley R} and Haaksma, {Mark E} and Smit, {Jasper M} and Hagens, {Laura A} and Heijnen, {Nanon F L} and Jonkman, {Annemijn H} and Frederique Paulus and Schultz, {Marcus J} and Girbes, {Armand R J} and Heunks, {Leo M A} and Bos, {Lieuwe D J} and Tuinman, {Pieter R}",

year = "2022",

month = nov,

doi = "10.1097/CCM.0000000000005620",

language = "English",

volume = "50",

pages = "1607--1617",

journal = "Critical Care Medicine",

issn = "0090-3493",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "11",

}

Heldeweg, MLA, Smit, MR, Kramer-Elliott, SR, Haaksma, ME, Smit, JM, Hagens, LA, Heijnen, NFL, Jonkman, AH, Paulus, F, Schultz, MJ, Girbes, ARJ, Heunks, LMA, Bos, LDJ & Tuinman, PR 2022, 'Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts', Critical Care Medicine, vol. 50, no. 11, pp. 1607-1617. https://doi.org/10.1097/CCM.0000000000005620

TY - JOUR

T1 - Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients

T2 - A Diagnostic Accuracy Study in Two Cohorts

AU - Heldeweg, Micah L A

AU - Smit, Marry R

AU - Kramer-Elliott, Shelley R

AU - Haaksma, Mark E

AU - Smit, Jasper M

AU - Hagens, Laura A

AU - Heijnen, Nanon F L

AU - Jonkman, Annemijn H

AU - Paulus, Frederique

AU - Schultz, Marcus J

AU - Girbes, Armand R J

AU - Heunks, Leo M A

AU - Bos, Lieuwe D J

AU - Tuinman, Pieter R

PY - 2022/11

Y1 - 2022/11

N2 - OBJECTIVES: To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population.DESIGN: A prospective diagnostic accuracy study with derivation and validation cohorts.SETTING: Three academic mixed ICUs in the Netherlands.PATIENTS: Consecutive adult ICU patients that received a lung ultrasound examination.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULT: The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome (n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS (n = 29) from CPE (n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77-0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS (n = 98) from CPE (n = 24) with a sensitivity of 31% (95% CI, 21-40%) and a specificity of 100% (95% CI, 86-100%).CONCLUSIONS: Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.

AB - OBJECTIVES: To determine the diagnostic accuracy of lung ultrasound signs for both the diagnosis of interstitial syndrome and for the discrimination of noncardiogenic interstitial syndrome (NCIS) from cardiogenic pulmonary edema (CPE) in a mixed ICU population.DESIGN: A prospective diagnostic accuracy study with derivation and validation cohorts.SETTING: Three academic mixed ICUs in the Netherlands.PATIENTS: Consecutive adult ICU patients that received a lung ultrasound examination.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULT: The reference standard was the diagnosis of interstitial syndrome (NCIS or CPE) or noninterstitial syndromes (other pulmonary diagnoses and no pulmonary diagnoses) based on full post-hoc clinical chart review except lung ultrasound. The index test was a lung ultrasound examination performed and scored by a researcher blinded to clinical information. A total of 101 patients were included in the derivation and 122 in validation cohort. In the derivation cohort, patients with interstitial syndrome (n = 56) were reliably discriminated from other patients based on the presence of a B-pattern (defined as greater than or equal to 3 B-lines in one frame) with an accuracy of 94.7% (sensitivity, 90.9%; specificity, 91.1%). For discrimination of NCIS (n = 29) from CPE (n = 27), the presence of bilateral pleural line abnormalities (at least two: fragmented, thickened or irregular) had the highest diagnostic accuracy (94.6%; sensitivity, 89.3%; specificity, 100%). A diagnostic algorithm (Bedside Lung Ultrasound for Interstitial Syndrome Hierarchy protocol) using B-pattern and bilateral pleural abnormalities had an accuracy of 0.86 (95% CI, 0.77-0.95) for diagnosis and discrimination of interstitial syndromes. In the validation cohort, which included 122 patients with interstitial syndrome, bilateral pleural line abnormalities discriminated NCIS (n = 98) from CPE (n = 24) with a sensitivity of 31% (95% CI, 21-40%) and a specificity of 100% (95% CI, 86-100%).CONCLUSIONS: Lung ultrasound can diagnose and discriminate interstitial syndromes in ICU patients with moderate-to-good accuracy. Pleural line abnormalities are highly specific for NCIS, but sensitivity is limited.

U2 - 10.1097/CCM.0000000000005620

DO - 10.1097/CCM.0000000000005620

M3 - Article

C2 - 35866658

SN - 0090-3493

VL - 50

SP - 1607

EP - 1617

JO - Critical Care Medicine

JF - Critical Care Medicine

IS - 11

ER -

Lung Ultrasound Signs to Diagnose and Discriminate Interstitial Syndromes in ICU Patients: A Diagnostic Accuracy Study in Two Cohorts

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