Objectives: To investigate the current evidence on the use of point-of-care chest ultrasonography in older patients and geriatric settings and present the current state of the art of chest ultrasound applications. Design: Special article based on a literature review with narrative analyses and expert clinical knowledge. Setting and participants: All studies performed in a geriatric setting were included. Observational and intervention studies and meta-analyses including participants aged ≥70 years were also considered, even if not specifically focused on a geriatric setting. Measures: Data on participant characteristics, diagnostic accuracy of chest ultrasonography, and outcomes were collected for each considered study. Data were analyzed and discussed with a particular focus on the possible applications and advantages of chest ultrasonography in geriatric medicine, underlining the possible areas of future research. Results: We found only 5 studies on the diagnostic accuracy and prognostic relevance of chest ultrasonography in geriatrics. However, several studies performed in emergency departments, intensive care units, and internal medicine wards included a large number of participants ≥70 years old; they suggest that chest ultrasonography may represent a valid aid to the diagnostics of acute dyspnea, pneumonia, acute heart failure, pneumothorax, and pleural diseases, with an accuracy in some cases superior to standard x-rays, especially when mobility limitation is present. Diaphragm ultrasonography may also represent a valid tool to guide mechanical ventilation weaning in older patients with acute respiratory failure. Conclusions and implications: Chest ultrasonography may represent a valid bedside diagnostic aid to the management of acute respiratory diseases in older patients. However, specific evidence is lacking for geriatric patients. Future research will need to focus on defining the reference standards and the diagnostic accuracy for older patients with frailty and multimorbidity, cost-efficacy and cost-effectiveness of the technique, its impact for clinical outcomes, and role for follow-up in the post-acute care.
The Geriatric Patient: The Ideal One for Chest Ultrasonography? A Review From the Chest Ultrasound in the Elderly Study Group (GRETA) of the Italian Society of Gerontology and Geriatrics (SIGG) / Ticinesi A.; Scarlata S.; Nouvenne A.; Lauretani F.; Incalzi R.A.; Ungar A.. - In: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION. - ISSN 1525-8610. - STAMPA. - 21:(2020), pp. 447-454.e6. [10.1016/j.jamda.2019.06.018]
The Geriatric Patient: The Ideal One for Chest Ultrasonography? A Review From the Chest Ultrasound in the Elderly Study Group (GRETA) of the Italian Society of Gerontology and Geriatrics (SIGG)
Ungar A.
2020
Abstract
Objectives: To investigate the current evidence on the use of point-of-care chest ultrasonography in older patients and geriatric settings and present the current state of the art of chest ultrasound applications. Design: Special article based on a literature review with narrative analyses and expert clinical knowledge. Setting and participants: All studies performed in a geriatric setting were included. Observational and intervention studies and meta-analyses including participants aged ≥70 years were also considered, even if not specifically focused on a geriatric setting. Measures: Data on participant characteristics, diagnostic accuracy of chest ultrasonography, and outcomes were collected for each considered study. Data were analyzed and discussed with a particular focus on the possible applications and advantages of chest ultrasonography in geriatric medicine, underlining the possible areas of future research. Results: We found only 5 studies on the diagnostic accuracy and prognostic relevance of chest ultrasonography in geriatrics. However, several studies performed in emergency departments, intensive care units, and internal medicine wards included a large number of participants ≥70 years old; they suggest that chest ultrasonography may represent a valid aid to the diagnostics of acute dyspnea, pneumonia, acute heart failure, pneumothorax, and pleural diseases, with an accuracy in some cases superior to standard x-rays, especially when mobility limitation is present. Diaphragm ultrasonography may also represent a valid tool to guide mechanical ventilation weaning in older patients with acute respiratory failure. Conclusions and implications: Chest ultrasonography may represent a valid bedside diagnostic aid to the management of acute respiratory diseases in older patients. However, specific evidence is lacking for geriatric patients. Future research will need to focus on defining the reference standards and the diagnostic accuracy for older patients with frailty and multimorbidity, cost-efficacy and cost-effectiveness of the technique, its impact for clinical outcomes, and role for follow-up in the post-acute care.
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