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

Abstract

Aims: The objective of the study was to assess the performance of lung ultrasonography (LUS) as compared to chest radiography and the clinical criteria for the diagnosis of pneumonia in children.Materials and methods: This was a retrospective study in which data were collected from medical files of 81 children admitted with a clinical suspicion of pneumonia in which both an LUS and a chest radiograph during the hospitalization were performed. Reference standard used for the diagnosis of pneumonia were chest radiographs (consolidation, parenchymal infiltrates, and interstitial infiltrate) and clinical criteria. LUSfindings were reported as normal, parenchymal consolidations and pleural effusions. Results: Radiological pneumonia was reported in 72 of the 81 patients (88.9%). LUS identified parenchymal consolidations in 62 cases. LUS correctly identified radiological pneumonia with a sensitivity of 79.2% and a specificity of 44.4%. The positive predictive value (PPV) was 91.9% and the negative predictive value (NPV) was 21.0%. When clinical criteria were used as reference standard, the sensitivity, specificity, PPV and NPV of correctly identifying clinical pneumonia cases by LUS (only consolidations) were 80.0%, 66.7%, 96.8% and 21.0%. When indicative for the presence of pneumonia either the ultrasound consolidation or the ultrasound detected pleural effusion were considered when the sensitivity, PPV and NPV increased to 96.0% (95%CI: 88.8-99.2), 97.3% (95%CI: 92.0-99.1), and 57.1% (95%CI: 27.7-82.2), respectively.Conclusions: In our opinion, our findings together withprevious ones available in the literature recommend LUS as a valuable investigation for the diagnosis of community-acquiredpneumonia in children.

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

“…Eighteen prospective cohort studies, five retrospective cohort studies, one randomized controlled trial, and one case‐control study were included. Three studies were conducted in North America, one in South America, in Europe,, five in Asia, and one in both South American and Asia . Study subjects were mostly infants, children, and adolescents except for two studies that included neonates .…”

“…The LUS training novice sonographers received varied greatly, ranging from 1 hour to the a priori–defined cutoff of 7 days of training . Ten studies were carried out in the ED and 13 in an inpatient setting with four in the ICU and nine in the ward . High‐frequency linear transducers (5–10 MHz) were most frequently utilized.…”

“…The presence of hepatization, alveolar‐interstitial syndrome (i.e., increased B‐lines surrounding the hepatization) and pleural effusions were most commonly used to define pneumonia (Table ). As a reference test for pneumonia, six studies used a combination of clinical judgment and imaging, one study used chest CT scan alone, two used clinical diagnosis alone, and 20 studies used CXR (Table ) . Among studies that used CXR as their reference test, the majority used only a posteroanterior (PA) or anteroposterior (AP) view, with only four also including a lateral view …”

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

“…Several studies demonstrated diagnostic accuracy with sensitivities ranging from 40% to 100% and specificities ranging from 44% to 100%. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Despite these variations in sensitivities and specificities, recent studies 31 and metanalyses 24 have shown very promising results on lung US accuracy.…”