Lung ultrasound in the diagnosis of pneumonia in children: proposal for a new diagnostic algorithm

Abstract

Background. Despite guideline recommendations, chest radiography (CR) for the diagnosis of community-acquired pneumonia (CAP) in children is commonly used also in mild and/or uncomplicated cases. The aim of this study is to assess the reliability of lung ultrasonography (LUS) as an alternative test in these cases and suggest a new diagnostic algorithm.Methods. We reviewed the medical records of all patients admitted to the pediatric ward from February 1, 2013 to December 31, 2014 with respiratory signs and symptoms. We selected only cases with mild/uncomplicated clinical course and in which CR and LUS were performed within 24 h of each other. The LUS was not part of the required exams recorded in medical records but performed independently. The discharge diagnosis, made only on the basis of history and physical examination, laboratory and instrumental tests, including CR (without LUS), was used as a reference test to compare CR and LUS findings.Results. Of 52 selected medical records CAP diagnosis was confirmed in 29 (55.7%). CR was positive in 25 cases, whereas LUS detected pneumonia in 28 cases. Four patients with negative CR were positive in ultrasound findings. Instead, one patient with negative LUS was positive in radiographic findings. The LUS sensitivity was 96.5% (95% CI [82.2%–99.9%]), specificity of 95.6% (95% CI [78.0%–99.9%]), positive likelihood ratio of 22.2 (95% CI [3.2–151.2]), and negative likelihood ratio of 0.04 (95% CI [0.01–0.25]) for diagnosing pneumonia.Conclusion. LUS can be considered as a valid alternative diagnostic tool of CAP in children and its use must be promoted as a first approach in accordance with our new diagnostic algorithm.

Lung ultrasound compared to chest X‐ray for diagnosis of pediatric pneumonia: A meta‐analysis

“…From this set of articles, 99 (12.6%) abstracts were identified for further analysis based on PRISMA analysis (Figure ). QUADAS review was applied to the 99 articles and 12 (1.5%) (Table ) were selected for inclusion in the meta‐analysis based on inclusion criteria, data collection, and lack of bias. All studies were observational.…”

“…QUADAS review was applied to the 99 articles and 12 [17][18][19][20][21][31][32][33][34][35][36][37] (1.5%) ( Table 1) were selected for inclusion in the meta-analysis based on inclusion criteria, data collection, and lack of bias. All studies were observational.…”

Lung ultrasound features of children with complicated and noncomplicated community acquired pneumonia: A prospective study

“…and specificity of 44%-100%). 8,10,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] On the contrary, our study focused on novel aspects. LUS allows the detailed description of lung pathology.…”

The Use of Lung Ultrasound to Monitor the Antibiotic Response of Community‐Acquired Pneumonia in Children: A Preliminary Hypothesis

“…For these reasons, lung US can easily be used not only for the diagnosis of CAP but also for monitoring of the response to therapy, as suggested by recent research . Nevertheless, the most of the published studies on this topic focused mainly on the accuracy of lung US in comparison with chest radiography in recognizing lung consolidations and bronchograms, without providing US details of the consolidations, such as the bronchogram position, morphologic characteristics, and dynamicity . Moreover, those studies including follow‐up lung US during CAP treatment did not include a detailed diagnostic lung US examination (done at time of diagnosis) and did not describe early lung US changes during the treatment in a detailed way …”

“…5 Nevertheless, the most of the published studies on this topic focused mainly on the accuracy of lung US in comparison with chest radiography in recognizing lung consolidations and bronchograms, without providing US details of the consolidations, such as the bronchogram position, morphologic characteristics, and dynamicity. [6][7][8][9] Moreover, those studies including follow-up lung US during CAP treatment did not include a detailed diagnostic lung US examination (done at time of diagnosis) and did not describe early lung US changes during the treatment in a detailed way. [10][11][12] In the following case series, we describe clinical and laboratory results as well as detailed lung US findings of 6 children with CAP, at baseline and 48 hours after beginning antibiotic treatment, showing the potential use of lung US in monitoring the response to antibiotic therapy.…”