Accuracy and reliability of bedside thoracic ultrasound in detecting pulmonary pathology in a heterogeneous pediatric intensive care unit population

Abstract

Purpose: This study was designed to access sensitivity and specificity of detection of lung abnormalities by the ultrasound (US) done by PICU providers of varying levels of experience compared to CXR and to assess the inter-rater reliability in the interpretation of the USG findings.Methods: Up to three US examinations were performed on patients meeting eligibility criteria. US examinations were reported by the operator and remotely by an expert reader. Both operator and readers interpretation were correlated with CXR read by an independent pulmonologist.Results: One hundred and thirty-five US examinations were performed on 91 patients over 9 months. Overall agreement between the operator and reader of the US was 0.53 (0.38-0.68).The agreement was highest with an expert-expert pair (0.75) and lowest with a novice-expert pair (0.27). Sensitivity and specificity of thoracic US to detect pulmonary abnormalities showed a high sensitivity by the operator (82.5%) compared to the reader (63.4%). Specificity was 25% and 42.8%, respectively. US was overall highly sensitive to detect pneumonia (96.4%) with a 100% PPV, but only modest for bronchiolitis.Conclusions: Lungs US is a rapid and sensitive bedside tool to assess lung consolidation in children in ICU. It, however, has low negative predictive values, and negative US examinations cannot rule out lung pathology.

Response to Letter to editor by Sabour et al

“…We thank Sabour et al for their interest in our paper 1 and welcome their suggestions. They pointed out that Cohen's kappa coefficient is influenced by the prevalence of each category.…”

Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases

“…The agreement between study physicians and expert readers increased gradually, peaking at six months of independent scanning after a five month period of supervised training [100]. In another prospective observational study, novel operators performing LUS showed greater sensitivity and less specificity detecting pneumonia compared to expert ones [38]. Agreement was very good among experts, in particular for the identification of consolidation patterns.…”

“…In the last years, LUS has been studied to test its efficacy in diagnosing pneumonia in children, with generally good results. When compared with chest X-ray and clinical scores, LUS showed good sensitivity and specificity [6,10,[31][32][33][34][35][36][37][38][39]. Moreover, LUS seemed to have greater sensitivity and less specificity than CXR, suggesting its usefulness as a screening tool for pneumonia [6,10,40].…”

Methodological issue on reliability of bedside thoracic ultrasound in detecting pulmonary pathology in a heterogeneous pediatric intensive care unit population

“…The authors reported that overall agreement between the operator and reader of the US was 0.53. Also, the agreement was highest with an expert‐expert pair (0.75) and lowest with a novice‐expert pair (0.27) …”

“…We read with great interest the article recently published by Tripathi and colleagues in a recent issue of the Journal of Clinical Ultrasound . The second purpose of the authors was to investigate the interrater reliability in the interpretation of thoracic sonograms performed by pediatric intensive care unit (PICU) providers with varying levels of expertise . The interrater agreement between operators and the readers was assessed with Cohen's kappa coefficient on 135 ultrasound (US) examinations performed on 91 patients.…”