Lung ultrasound in outpatient approach to children with suspected COVID 19

Abstract

Background Children with COVID 19 infection (CV19) generally have a mild disease whose main symptoms are fever and cough. Dyspnoea and hypoxemia are rarely reported and few data are available on the frequency and extent of lung involvement in children with CV19. In addition, due to the limited availability of diagnostic tests in Italy during the pandemic period and the relative reliability of the test results, the diagnostic suspicion of CV19 infection in most of the children was difficult to confirm. The aim of this study is to evaluate if lung ultrasound (LUS) was able to highlight typical interstitial lung lesions in children with persistent cough and suspected CV19, providing corroborating evidence of CV19 infection. Methods We retrospectively analysed the data of 32 children who came consecutively to our outpatient observation in the period between March 1st and April 30th, 2020 because of the presence of persistent cough for at least 3 days and with suspected CV19. All the children undergone clinical examination, oximetry measurement and LUS. Results Twenty over thirty-two children had US lesions compatible with the presence of CV19, many of them without clinical signs of respiratory distress. LUS is much more sensitive than clinical examination to detect lung injury in children with suspected CV19. Conclusion In the absence of reliable, highly sensitive diagnostic tests or when nasal swab is unworkable or there are too many requests to be performed quickly due to the pandemic, LUS should be used in children with persistent cough for whom a CV19 is suspected because it can highlight undiagnosed interstitial lung lesions and reinforce the diagnostic suspicion of CV19 This approach can be very useful in outpatient settings and in areas with limited medical resources such as developing countries.

Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review

“… 85 In the absence of reliable, highly sensitive diagnostic tests or when there are too many requests for nasal swab, the LUS can be used to diagnose children with suspected COVID-19 and persistent cough, because ultrasound can highlight the interstitial lung lesions caused by COVID-19 and can be used to strengthen the diagnostic ability in children with suspected COVID-19 pneumonia. 86 Standardized LUS protocols combine ultrasound probability patterns with clinical phenotypes, and both LUS high likelihood patterns and LUS moderate likelihood patterns are very sensitive to the exclusion of interstitial pneumonia, which increases in sensitivity when the child’s clinical symptoms worsen. 87 During the COVID-19 pandemic, LUS can quickly identify children with or without COVID-19 pneumonia infection, which helps clinicians to quickly guide the management of children to use hospital resources more efficiently.…”

Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases

“…In particular, specificity was 93.75% and sensibility 83.33%, with a PPV as high as 90.9% [78]. These data suggest that LUS could be used as a screening tool in children with probable SARS-CoV2 symptomatic infection, aiming to determine those with greater lung involvement and higher risk for respiratory support [12,79,80]. Nevertheless, LUS should not be considered a diagnostic tool for COVID-19, as ultrasonographic patterns are non-specific and shared with other respiratory viral infections, such as acute bronchiolitis [81].…”

Lung Ultrasound Findings in Healthy Children and in Those Who Had Recent, Not Severe COVID-19 Infection

“…LUS is widely implemented for the diagnosis of pulmonary disease in children [ 1 , 2 , 3 , 4 , 5 , 6 ], and the COVID-19 pandemic has shown its utility in daily practice [ 9 , 10 , 11 ]. Despite its utility, systems for pulmonary disease severity classification by LUS in a pediatric population are lacking [ 1 , 2 , 4 ], and the definition of a normal LUS examination remains unclear.…”

“…Further, if the former is the case, does this pulmonary damage relate to the severity of the disease? Many articles have focused on the role of LUS for the early diagnosis and follow-up of symptomatic COVID-19 in both adults [ 6 ] and children [ 9 , 10 , 11 , 12 ]. However, studies on the use of LUS evaluation in mid-term follow-up on asymptomatic pediatric COVID-19 patients are sparse.…”