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Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.

Abstract：

BACKGROUND:Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia. METHODS:Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset. RESULTS:Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91-0.96). CONCLUSIONS:Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically-confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia.

journal_name

Respir Med

journal_title

Respiratory medicine

authors

Ellington LE,Gilman RH,Chavez MA,Pervaiz F,Marin-Concha J,Compen-Chang P,Riedel S,Rodriguez SJ,Gaydos C,Hardick J,Tielsch JM,Steinhoff M,Benson J,May EA,Figueroa-Quintanilla D,Checkley W,Lung Ultrasound for Pneumonia Asse

doi

10.1016/j.rmed.2017.05.007

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

57-64

eissn

0954-6111

issn

1532-3064

pii

S0954-6111(17)30149-X

journal_volume

128

pub_type

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Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.