Performance of lung ultrasonography in children with community-acquired pneumonia

Abstract

BackgroundThere are few prospective evaluations of point-of-care ultrasonography (US) for the diagnosis of pediatric community-acquired pneumonia (CAP). In particular, there are very few data concerning the efficiency of US in comparison with that of chest radiography (CR) in defining different kinds of lung alterations in the various pulmonary sections. The aim of this study was to bridge this gap in order to increase our knowledge of the performance of US in diagnosing CAP in childhood.MethodsA total of 103 children (56 males, 54.4%; mean age ± standard deviation 5.6 ± 4.6 years) admitted to hospital with a clinical diagnosis of suspected CAP were prospectively enrolled and underwent CR (evaluated by an independent expert radiologist) and lung US (performed by a resident in paediatrics with limited experience in US). The performance of US in diagnosing CAP (i.e. its sensitivity, specificity, and positive and negative predictive values) was compared with that of CR.ResultsA total of 48 patients had radiographically confirmed CAP. The sensitivity, specificity, and positive and negative predictive values of US in comparison with CR were respectively 97.9%, 94.5%, 94.0% and 98.1%. US identified a significantly higher number of cases of pleural effusion, but the concordance of the two methods in identifying the type of CAP was poor.ConclusionUS can be considered a useful means of diagnosing CAP in children admitted to an Emergency Department with a lower respiratory tract infection, although its usefulness in identifying the type of lung involvement requires further evaluation.

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

“…15,16,22 Two studies (25%) enrolled patients with suspected neonatal pneumonia and severe disease, 22,24 and 6 studies (75%) enrolled children with suspected community-acquired pneumonia. [13][14][15][16]21,23 One study 15 enrolled 9 children aged $18 years, and the information on these participants was not included in our analysis.…”

“…Results of the search were then reviewed by the research team. We also provided the 2 information specialists with 3 studies [13][14][15] as a test set to check the completeness of the search results. All titles and abstracts relevant to our study were retrieved and searched for full texts.…”

“…We excluded 3 review articles, 1 study in adults, and 3 studies that did not fit our methodologic criteria. We selected 8 studies for analysis, [13][14][15][16][21][22][23][24] of which 6 (75%) were conducted in the general pediatric population and 2 (25%) were conducted in neonates ,28 days of age. Three studies 13,15,16 were conducted in emergency departments, 2 in hospital wards, 21,23 1 in the pediatric intensive care unit, 14 and 2 in the neonatal intensive care unit.…”

“…Seven studies (88%) were blinded to outcomes of CR before LUS performance and interpretation. [13][14][15][16][21][22][23] Five studies were conducted in Italy, 13,14,16,21,23 1 in China, 22 1 in the United States, 15 and 1 in Egypt. 24 Only 3 studies (38%) followed the disease course until the consolidation was resolved.…”

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?…”