Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

JAMA Pediatrics (Impact Factor: 5.73). 12/2012; 167(2):1-7. DOI: 10.1001/2013.jamapediatrics.107
Source: PubMed

ABSTRACT OBJECTIVE To determine the accuracy of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults by a group of clinicians. DESIGN Prospective observational cohort study. SETTING Two urban emergency departments. PARTICIPANTS Patients from birth to age 21 years undergoing chest radiography for suspected community-acquired pneumonia. INTERVENTION After documenting clinical examination findings, clinicians with 1 hour of focused training used ultrasonography to diagnose pneumonia in children and young adults. MAIN OUTCOMES MEASURES Test performance characteristics for the ability of ultrasonography to diagnose pneumonia were determined using chest radiography as a reference standard. Subgroup analysis was performed in patients having lung consolidation exceeding 1 cm with sonographic air bronchograms detected on ultrasonography; specificity and positive likelihood ratio (LR) were calculated to account for lung consolidation of 1 cm or less with sonographic air bronchograms undetectable by chest radiography. RESULTS Two hundred patients were studied (median age, 3 years; interquartile range, 1-8 years); 56.0% were male, and the prevalence of pneumonia by chest radiography was 18.0%. Ultrasonography had an overall sensitivity of 86% (95% CI, 71%-94%), specificity of 89% (95% CI, 83%-93%), positive LR of 7.8 (95% CI, 5.0-12.4), and negative LR of 0.2 (95% CI, 0.1-0.4) for diagnosing pneumonia by visualizing lung consolidation with sonographic air bronchograms. In subgroup analysis of 187 patients having lung consolidation exceeding 1 cm, ultrasonography had a sensitivity of 86% (95% CI, 71%-94%), specificity of 97% (95% CI, 93%-99%), positive LR of 28.2 (95% CI, 11.8-67.6) and negative LR of 0.1 (95% CI, 0.1-0.3) for diagnosing pneumonia. CONCLUSION Clinicians are able to diagnose pneumonia in children and young adults using point-of-care ultrasonography, with high specificity.

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    • "A number of studies have described the usefulness of LUS in the pediatric population, from transient tachypnea of the newborn [53] to respiratory distress syndrome [54], from bronchiolitis [55] to post-cardiac surgery lung complications [56] and anesthesia-induced atelectasis [57]. In the pediatric patients LUS is especially valuable in detecting pneumonia, with a sensitivity even higher than that of chest X-ray [58-60]. Given the small size of a child’s chest, a linear probe allows the best visualization of the lungs in most cases, irrespective of the depth of the main target of the examination. "
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    ABSTRACT: In the last 15 years, a new imaging application of sonography has emerged in the clinical arena: lung ultrasound (LUS). From its traditional assessment of pleural effusions and masses, LUS has moved towards the revolutionary approach of imaging the pulmonary parenchyma, mainly as a point-of-care technique. Although limited by the presence of air, LUS has proved to be useful in the evaluation of many different acute and chronic conditions, from cardiogenic pulmonary edema to acute lung injury, from pneumothorax to pneumonia, from interstitial lung disease to pulmonary infarctions and contusions. It is especially valuable since it is a relatively easy-to-learn application of ultrasound, less technically demanding than other sonographic examinations. It is quick to perform, portable, repeatable, non-ionizing, independent from specific acoustic windows, and therefore suitable for a meaningful evaluation in many different settings, both inpatient and outpatient, in both acute and chronic conditions. In the next few years, point-of-care LUS is likely to become increasingly important in many different clinical settings, from the emergency department to the intensive care unit, from cardiology to pulmonology and nephrology wards.
    Cardiovascular Ultrasound 07/2014; 12(1):25. DOI:10.1186/1476-7120-12-25 · 1.34 Impact Factor
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    • "These ultrasonographic findings can be investigated using a high frequency linear transducer as small subpleural consolidations as well as small pleural effusions can be missed with lower frequency curvilinear probes and cannot be visualized by chest X-ray [4,15,16]. Larger footprint lower frequency curvilinear (up to 60 mm in length) or microconvex probes can be used to rapidly assess the extent of lung pathology, especially in patients with impending respiratory failure [5,15]. Interstitial syndrome on ultrasound is visualized as numerous B-lines (at least 3 per field of view) [8,11,12]. "
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    ABSTRACT: Background Lung ultrasound has been shown to identify in real-time, various pathologies of the lung such as pneumonia, viral pneumonia, and acute respiratory distress syndrome (ARDS). Lung ultrasound maybe a first-line alternative to chest X-ray and CT scan in critically ill patients with respiratory failure. We describe the use of lung ultrasound imaging and findings in two cases of severe respiratory failure from avian influenza A (H7N9) infection. Methods Serial lung ultrasound images and video from two cases of H7N9 respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation in a tertiary care intensive care unit were analyzed for characteristic lung ultrasound findings described previously for respiratory failure and infection. These findings were followed serially, correlated with clinical course and chest X-ray. Results In both patients, characteristic lung ultrasound findings have been observed as previously described in viral pulmonary infections: subpleural consolidations associated or not with local pleural effusion. In addition, numerous, confluent, or coalescing B-lines leading to ‘white lung’ with corresponding pleural line thickening are associated with ARDS. Extension or reduction of lesions observed with ultrasound was also correlated respectively with clinical worsening or improvement. Coexisting consolidated pneumonia with sonographic air bronchograms was noted in one patient who did not survive. Conclusions Clinicians with access to point-of-care ultrasonography may use these findings as an alternative to chest X-ray or CT scan. Lung ultrasound imaging may assist in the efficient allocation of intensive care for patients with respiratory failure from viral pulmonary infections, especially in resource scarce settings or situations such as future respiratory virus outbreaks or pandemics.
    Critical ultrasound journal 05/2014; 6(1):6. DOI:10.1186/2036-7902-6-6
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    • "This discordant result may have been due to the different limit for the CR detection of lung consolidation. Shah et al. have reported that lung consolidations of ≤1 cm are undetectable by CR, which remains negative or suggests moderate infiltration resembling non-alveolar disease [17]. There were similar significant differences when the site of lung damage suggesting CAP was evaluated: the concordance of the two methods was only moderate, thus confirming the difficulty of identifying lung damage by US regardless of the type of CAP. "
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    ABSTRACT: There 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. A 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. A 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. US 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.
    Italian Journal of Pediatrics 04/2014; 40(1):37. DOI:10.1186/1824-7288-40-37 · 1.52 Impact Factor
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