Background: Early detection of pneumothorax is critically important. Several
studies have shown that chest ultrasonography (CUS) is a highly sensitive and
specific tool. The present systematic review and meta-analysis was designed to
evaluate the diagnostic accuracy of CUS and chest radiography (CXR) for
detection of pneumothorax.
Materials and Methods: The literature search was conducted using PubMed,
EMBASE, Cochrane, CINAHL, SUMSearch, Trip databases, and review article
references. Eligible articles were defined as diagnostic studies on patients
suspected for pneumothorax who underwent chest computed tomography (CT)
scan and those assessing the screening role of CUS and CXR.
Results: The analysis showed the pooled sensitivity and specificity of CUS
were 0.87 (95% CI: 0.81-0.92; I2= 88.89, P<0.001) and 0.99 (95% CI: 0.98-0.99; I2=
86.46, P<0.001), respectively. The pooled sensitivity and specificity of CXR were
0.46 (95% CI: 0.36-0.56; I2= 85.34, P<0.001) and 1.0 (95% CI: 0.99-1.0; I2= 79.67,
P<0.001), respectively. The Meta regression showed that the sensitivity (0.88;
95% CI: 0.82 - 0.94) and specificity (0.99; 95% CI: 0.98 - 1.00) of ultrasound
performed by the emergency physician was higher than by non-emergency
physician. Non-trauma setting was associated with higher pooled sensitivity
(0.90; 95% CI: 0.83 – 0.98) and lower specificity (0.97; 95% CI: 0.95 – 0.99).
Conclusion: The present meta-analysis showed that the diagnostic accuracy of
CUS was higher than supine CXR for detection of pneumothorax. It seems that
CUS is superior to CXR in detection of pneumothorax, even after adjusting for
possible sources of heterogeneity.
Key words: Pneumothorax; Ultrasonography; Radiography; Diagnostic
tests, Routin
