Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults
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.
- JAMA Pediatrics 12/2012; 167(2):1-2. DOI:10.1001/2013.jamapediatrics.409 · 4.25 Impact Factor
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ABSTRACT: Chest ultrasound is a useful diagnostic tool in adult emergency medicine. Echography does not generate a clear image of the lung but is able to generate artifacts that are combined in disease-specific profiles. Reflections of the pleural image appear as short straight lines also known as A-lines. Vertical, comet-tail artifacts departing from the pleura are named B-lines. The former are present in the normal lung while the latter have been described in the adult wet lung. Lung ultrasonography outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. Neonatologists and pediatricians are now adapting lung ultrasound to their specific clinical issues. The normal image is relatively unchanged throughout the age span, while progressively fading B-lines describe the fluid-to-air transition of the neonatal lung. Also, an homogeneous white (hyperechogenic) lung with pleural image abnormalities and absence of spared areas is accurate in diagnosing Respiratory Distress Syndrome (RDS). The prevalence of A-lines in the upper lung fields with B-lines at the bottom fields (aka double lung point artifact) is highly sensitive and specific in describing Transient Tachypnea of the Newborn. Infantile pneumonia has recently been proved an accurate diagnosis by ultrasound after a short training. In summary, chest ultrasonography has no ground to replace conventional chest radiology tout court. However, when appropriately applied, a lung ultrasound scan can save time and radiation exposure to achieve a critical diagnosis.
Article: Pneumonia.Pediatrics in Review 10/2013; 34(10):438-456. DOI:10.1542/pir.34-10-438 · 0.82 Impact Factor