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Table 4 Test characteristics of ultrasound examination, modified Boston examination, NT-proBNP and combination of ultrasound examination and NT-proBNPa

From: Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting

Characteristic Ultrasound examinationb Modified Boston criteria scoring NT-proBNP Ultrasound examination + NT-proBNPc P valued
Sensitivity 100%
(95% CI 98 to 100)
85%
(95% CI 79 to 89)
92%
(95% CI 88 to 95)
100%
(95% CI 98 to 100)
< 0.01
Specificity 95%
(95% CI 91 to 100)
86%
(95% CI 82 to 90)
89%
(95% CI 84 to 92)
100%
(95% CI 97 to 100)
< 0.01
NPV 100%
(95% CI 98 to 100)
80%
(95% CI 77 to 85)
86%
(95% CI 82 to 90)
100%
(95% CI 98 to 100)
< 0.01
PPV 96%
(95% CI 93 to 100)
90%
(95% CI 86 to 93)
90%
(95% CI 85 to 94)
100%
(95% CI 96 to 100)
< 0.01
LR+ 20
(95% CI 1.98 to 89.94)
6.1
(95% CI 1.65 to 18.48)
8.36
(95% CI 1.72 to 33.86)
Infinite < 0.01
LR- 0 0.18
(95% CI 0.07 to 0.52)
0.09
(95% CI 0.02 to 0.23)
0 < 0.01
AUROC 0.94
(95% CI: 0.90 to 0.97)
0.86
(95% CI 0.80 to 0.91)
0.90
(95% CI 0.84 to 0.94)
0.99
(95% CI 0.98 to 1.00)
< 0.01
  1. aNPV, negative predictive value; PPV, positive predictive value; LR+, positive likelihood ratio; LR-, negative likelihood ratio; AUROC, area under receiver-operating curve; NT-proBNP, amino terminal pro-brain natriuretic peptide; UE, ultrasound examination. bUE alone was statistically significantly more accurate in diagnosing HF than the modified Boston criteria and NT-proBNP (better sensitivity, specificity, NPV, PPV, LR+, LR- and AUROC; P < 0.01). cThe combination of UE and NT-proBNP was the supreme method in diagnosing HF in a prehospital setting; when compared with UE alone, it had equal results in sensitivity, NPV and LR- (P = 0.99) and significantly better results in specificity, PPV and AUROC (P < 0.01). Compared with Boston modified criteria or NT-proBNP alone, UE + NT-proBNP was significantly better with regard to all characteristics (sensitivity, specificity, NPV, PPV, LR+, LR- and AUROC; P < 0.01). dThe comparison of the four methods was done using the χ2 test with the Bonferroni correction for multiple comparisons. The AUROC accuracy of UE (lung comet-tail sign); NT-proBNP; Boston criteria for diagnosing HF (clinical assessment); and the combination of ultrasound, NT-proBNP and Boston criteria were calculated and compared with univariate Z-score testing. AUROC was compared using the technique proposed by Hanley and Mc Neil [20] and Jannuzzi et al. [21].