DIAGNOSTIC ACCURACY OF POINT OF CARE ULTRASONOGRAPHY AND CHEST X-RAY FOR RESPIRATORY DISTRESS IN THE EMERGENCY ROOM

Abstract

Objective: To compare the sensitivity, specificity and diagnostic accuracy of point of care ultrasonography (POCUS) and X-ray chest in patients presenting with suspected respiratory distress in the emergency room (ER) keeping HRCT chest as reference standard

Study Design: Diagnostic validation study 

Place and Duration of Study: Department of Emergency Medicine (EM), Combined Military Hospital, Rawalpindi from Jan- June 2025

Methodology: A total of 90 patients were analyzed in the final assessment protocol who underwent POCUS, CXR, and HRCT chest. Primary study outcome was sensitivity, specificity, positive, negative predictive value and diagnostic accuracy of point of care ultrasonography (POCUS) and X-ray chest in patients presenting with suspected respiratory distress in the emergency room (ER) keeping HRCT chest as gold standard.

Results: Compared to the gold standard HRCT chest, CXR showed a sensitivity of 57.7%, specificity of 90.6%, a positive and negative predictive value of 71.4% and 84.1%. The overall diagnostic accuracy was 81.1%. POCUS when compared to gold standard HRCT chest showed a sensitivity of 88.5%, specificity of 93.8%, with a positive and negative predictive value of 85.2% and 95.2% respectively. The overall diagnostic accuracy was 92.2%.

Conclusion: Compared to HRCT, POCUS showed higher sensitivity, specificity and overall diagnostic accuracy when compared to CXR findings. POCUS also has the advantage of being easily portable, available at bedside, with no radiation exposure making it an attractive diagnostic tool in the emergency room with the appropriate training.