Accuracy of pleural puncture sites: A prospective comparison of clinical examination with ultrasound

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dc.contributor.authorDiacon A.H.
dc.contributor.authorBrutsche M.H.
dc.contributor.authorSoler M.
dc.date.accessioned2011-05-15T16:16:00Z
dc.date.available2011-05-15T16:16:00Z
dc.date.issued2003
dc.description.abstractStudy objective: To assess the value of chest ultrasonography vs clinical examination for planning of diagnostic pleurocentesis (DPC). Design: Prospective comparative study. Setting: Pulmonary unit of a tertiary teaching hospital. Patients and participants: Sixty-seven consecutive patients referred to 30 physicians of varying degrees of experience for DPC. Interventions: Based on clinical data and examination, physicians determined whether and where a DPC should be performed. Selected puncture sites were evaluated with ultrasound and considered accurate when ≥ 10 mm fluid perpendicular to the skin were present. Measurements and results: In 172 of 255 cases (67%), a puncture site was proposed. Twenty-five sites (15%) were found to be inaccurate on ultrasound examination, and a different, accurate site was established in 20 of these cases. Physicians were unable to locate a puncture site in 83 cases (33%). Among these, ultrasound demonstrated an accurate site in 45 cases (54%), while a safe tap was truly impossible in 38 cases (46%). Overall, ultrasound prevented possible accidental organ puncture in 10% of all cases and increased the rate of accurate sites by 26%. The sensitivity and specificity for identifying a proper puncture site with clinical examination compared to ultrasound as the "gold standard" were 76.6% and 60.3% (positive and negative predictive values, 85.5% and 45.8%, respectively). Risk factors associated with inaccurate clinical site selection were as follows: small effusion (p < 0.001), evidence of fluid loculation on chest radiography (p = 0.01; relative risk, 7.8; 95% confidence interval, 1.9 to 32.9), and sharp costodiaphragmatic angle on chest radiography (p < 0.001; relative risk, 7.0; 95% confidence interval, 2.3 to 15.2). Experienced physicians did not perform better than physicians in training. Conclusions: Puncture site selection with bedside ultrasonography increases the yield of and potentially reduces complication rate in DPC. Physician experience does not predict the accuracy of selected puncture sites.
dc.description.versionArticle
dc.identifier.citationChest
dc.identifier.citation123
dc.identifier.citation2
dc.identifier.issn00123692
dc.identifier.other10.1378/chest.123.2.436
dc.identifier.urihttp://hdl.handle.net/10019.1/13591
dc.subjectaccuracy
dc.subjectadult
dc.subjectaged
dc.subjectarticle
dc.subjectchest ultrasonography
dc.subjectclinical examination
dc.subjectcontrolled study
dc.subjectdiagnostic procedure
dc.subjectexperience
dc.subjectfemale
dc.subjecthuman
dc.subjectintermethod comparison
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectphysician
dc.subjectpleura effusion
dc.subjectpleura fluid
dc.subjectpriority journal
dc.subjectrisk factor
dc.subjectsafety
dc.subjectthoracocentesis
dc.subjectthorax examination
dc.subjectthorax radiography
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPleural Effusion
dc.subjectPoint-of-Care Systems
dc.subjectPostoperative Complications
dc.subjectProspective Studies
dc.subjectPunctures
dc.subjectSensitivity and Specificity
dc.subjectThoracostomy
dc.subjectUltrasonography, Interventional
dc.titleAccuracy of pleural puncture sites: A prospective comparison of clinical examination with ultrasound
dc.typeArticle
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