Bedside lung ultrasound in the diagnosis of pneumonia in very old patients

In several studies mainly undertaken in emergency departments, lung ultrasound (LUS) has a sensitivity similar and/or superior to the one of chest X-ray (CXR) in the diagnosis of pneumonia. The aim was to evaluate if LUS may be applied as first step imaging examination in the diagnosis of pneumonia also in medical/geriatric setting other than in emergency departments. We reviewed the clinical files of 128 very old patients (61 M and 67 F, age ranging from 78 to 94 yrs, mean 84.8 year) discharged in a period of 20 months with diagnosis of pneumonia in which both CXR and LUS were performed. The majority of patients had co-morbidities and/or motor disability and/or cognitive impairment. The sensitivity of LUS resulted in 82.03% (105/128) and those of CXR 75.78% (97/128): the difference was statistically not significant. Only the presence of pleural effusion resulted significantly higher with LUS when compared with the one observed with CXR (55.46% vs 37.5%, P=0.0039). The superiority of LUS with respect to CXR, although statistically not significant, suggests the use of ultrasound as a first step examination not only in emergency departments or in pediatric setting but also in very old patients with symptoms suspicious of pneumonia. The use of LUS in frail old patients with multiple co-morbidities can be easily carried out at the bedside and provides diagnostic information avoiding delaying the appropriate antimicrobial treatment.