SERAFINO MANSUETO AWARD | Bedside lung ultrasound in the diagnosis of community acquired pneumonia in 569 elderly patients in an Internal Medicine department

Premises and Purpose of the study: Aim of the study is to evaluate the clinical performance and utility of Bedside Lung ultrasound in diagnosis of community acquired pneumonia (CAP) in elderly patients. Materials and Methods: 569 patients were studied from January 2021 to 2025; final diagnosis: 77 acute bronchitis/COPD (mean age: 79,1Y); pneumonia: 492 (mean age: 79,4Y); Clinical Diagnosis (CD) (based on patient history, physical examination and laboratory tests), chest x-ray (CXR) and lung ultrasound (LUS) were evaluated. Corresponding Sensitivity, specificity, overall diagnostic accuracy (ODA) (and AUROC) of were calculated. Results: CD: True+: 135; true-: 59; False+: 18; False-: 357 (SENS: 27%; SPEC: 76,6%; ODA: 9,3% PPV: 88,2% NPV: 14,2%) (AU-ROC: 0,5203 SEAUC=0,035); CXR: True+: 244; true-:43; False-: 34; False-: 248 (SENS: 49,6; SPEC: 55,8%; ODA: 17%; PPV: 87,8%; NPV: 14,8%) (AU-ROC: 0,5272 SEAUC=0,0349); LUS: True+: 464; True-: 58; False+: 19; False-: 28 (SENS: 94,3%; SPEC: 75,3%; ODA: 90,9%; PPV: 96,1%; NPV: 67,4%) (AU-ROC: 0,8175 SEAUC=0,0202); pneumonia was diagnosed: by CRX and LUS in 129/492 (26,21%); only by LUS in 335/492 (68%) (in 28/335 -8,3%- Pneumonia diagnosis was clinically unexpected); only by CT in 28/492 (5,6%) cases. Conclusions: CD of CAP in the elderly is difficult and unsatisfactory; the radiological one is obtainable in about half of the cases; Bedside Lus diagnoses pneumonia correctly in 94.3% (and alone in 68%) of elderly people; It has excellent sensitivity (94.3%) but a non -optimal specificity (75.3%); In 8% of cases CAP diagnosis was unexpected.