Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis

Abstract

BACKGROUND AND OBJECTIVE: Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia. METHODS:We performed a systematic search in PubMed, Embase, the Cochrane Library, Scopus, Global Health, World Health Organization-Libraries, and Latin American and Caribbean Health Sciences Literature of studies comparing LUS diagnostic accuracy against a reference standard. We used a combination of controlled key words for age ,18 years, pneumonia, and ultrasound. We identified 1475 studies and selected 15 (1%) for further review. Eight studies (765 children) were retrieved for analysis, of which 6 (75%) were conducted in the general pediatric population and 2 (25%) in neonates. Eligible studies provided information to calculate sensitivity, specificity, and positive and negative likelihood ratios. Heterogeneity was assessed by using Q and I 2 statistics.RESULTS: Five studies (63%) reported using highly skilled sonographers. Overall methodologic quality was high, but heterogeneity was observed across studies. LUS had a sensitivity of 96% (95% confidence interval [CI]: 94%-97%) and specificity of 93% (95% CI: 90%-96%), and positive and negative likelihood ratios were 15.3 (95% CI: 6.6-35.3) and 0.06 (95% CI: 0.03-0.11), respectively. The area under the receiver operating characteristic curve was 0.98. Limitations included the following: most studies included in our analysis had a low number of patients, and the number of eligible studies was also small. Dr Pereda conceptualized and designed the study, reviewed all abstracts and selected articles to be included in the meta-analysis, was responsible for data collection, and drafted the initial manuscript; Dr Chavez conceptualized and designed the study, reviewed all abstracts and selected articles to be included in the meta-analysis, was responsible for data collection, led the analysis, and drafted the initial manuscript; Dr Hooper-Miele participated in analysis and interpretation of results, critically revised ultrasound methods used by selected studies, and reviewed and revised the manuscript; Drs Gilman, Steinhoff, Ellington, and Tielsch participated in the analysis and interpretation of results and reviewed and revised the manuscript; Ms Gross and Ms Price conducted the literature search and reviewed and revised the manuscript; Dr Checkley conceptualized and designed the study, contributed equally to the analysis, drafted the initial manuscript, and had ultimate oversight over the study conduct, analysis plan, and writing of the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.www.pediatrics.org/cgi

Performance of lung ultrasonography for the diagnosis of communityacquired pneumonia in hospitalized children

“…densities, or pleural effusion). A meta-analysis including 8 prospective studies performed in neonates and pediatric population and enrolling 765 children showed that LUS had an overall sensitivity of 95% (95%CI: 94-97), positive likelihood ratio of 15.3 and negative likelihood ratio of 0.06 for the presence of pneumonia as diagnosed based on clinical criteria and radiographic findings [8].…”

Ultrasonographic Visualization of an Aspirated Foreign Body in Lung Tissue

“…It is used to confirm endotracheal tube placement and for visualization of pneumothorax, alveolar pathologies, lung consolidation, and pleural effusion (7). Studies have shown that LUS is superior to direct radiographs in visualizing alveolar pathologies (3,4). Ultrasonography studies have been performed to visualize FBs located in different parts of the body.…”

“…Posteroanterior (PA) and lateral chest radiographs should be performed when FB aspiration is suspected. Lung ultrasonography (LUS) is an alternative to direct radiographs in emergency departments to visualize lung pathologies (1)(2)(3)(4). In this case report, the visualization of aspirated foreign body (FB) and surrounding inflammation by LUS is described.…”

Why Ultrasound May Ameliorate the Approach to Pneumonia in Children

“…In 2008 Copetti and Cattarossi published the first study reporting the high accuracy of lung ultrasound in detecting CAP in children [4] . Afterwards, several research teams with different expertise in ultrasounds confirmed the reproducibility of these results on different cohorts ofinpatients [5][6][7][8] Recently, current evidences have been included in a meta-analysis which further confirmed the high accuracy of ultrasound in the diagnosis of children pneumonia [9] As it appears, pediatricians may now choose between two imaging techniques. The question is: which is the best?…”