Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings (original) (raw)
Related papers
Utility of lung ultrasound in childhood pneumonia in a tertiary care center
International Journal of Contemporary Pediatrics, 2020
Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role ...
International Journal of Emergency Medicine
Background Lung ultrasound (LUS) is an effective tool for diagnosing pneumonia; however, this has not been well studied in resource-limited settings where pneumonia is the leading cause of death in children under 5 years of age. Objective The objective of this study was to evaluate the diagnostic accuracy of bedside LUS for diagnosis of pneumonia in children presenting to an emergency department (ED) in a resource-limited setting. Methods This was a prospective cross-sectional study of children presenting to an ED with respiratory complaints conducted in Nepal. We included all children under 5 years of age with cough, fever, or difficulty breathing who received a chest radiograph. A bedside LUS was performed and interpreted by the treating clinician on all children prior to chest radiograph. The criterion standard was radiographic pneumonia, diagnosed by a panel of radiologists using the Chest Radiography in Epidemiological Studies methodology. The primary outcome was sensitivity an...
Pediatric Pulmonology
Background: Pneumonia is a leading cause of death in children of low-resource settings. Barriers to care include an early and accurate diagnosis. Lung ultrasound is a novel tool for the identification of pediatric pneumonia; however, there is currently no standardized approach to train in image acquisition and interpretation of findings in epidemiological studies. We developed a training program for physicians with limited ultrasound experience on how to use ultrasound for the diagnosis of pediatric pneumonia and how to standardize image interpretation using a panel of readers. Methods: Twenty-five physicians participating in the training program conducted lung ultrasounds in all children with suspected pneumonia, aged 3 to 35 months, presenting to three subdistrict hospitals in Sylhet, Bangladesh, between June 2015 and September 2017. Results: A total of 9051 pediatric lung ultrasound assessments were conducted through 27 months of data collection. Study physicians underwent training and all were successfully standardized, achieving 91% agreement and maintained a sensitivity and specificity of 88% and 92%, respectively, when their diagnosis was compared with experts. Overall kappa between two readers was high (0.86, 95% confidence interval [CI], 0.84-0.87), and remained high when a third expert reader was included (0.80, 95% CI, 0.79-0.81). Agreement and kappa statistics were similarly high when stratified by age, sex, presence of danger signs, or hypoxemia. Conclusions: Lung ultrasound is a novel tool for the diagnosis of pediatric pneumonia with evidence supporting its validity and feasibility of implementation. Here we introduced a training program that resulted in a high level of inter-sonographer agreement.
Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan
Pediatric Pulmonology, 2020
Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. Methods: We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia.
Children, 2021
Background: Pneumonia is the leading cause of death among children; thus, a correct early diagnosis would be ideal. The imagistic diagnosis still uses chest X-ray (CXR), but lung ultrasound (LUS) proves to be reliable for pneumonia diagnosis. The aim of our study was to evaluate the sensitivity and specificity of LUS compared to CXR in consolidated pneumonia. Methods: Children with clinical suspicion of bacterial pneumonia were screened by LUS for pneumonia, followed by CXR. The agreement relation between LUS and CXR regarding the detection of consolidation was evaluated by Cohen’s kappa test. Results: A total of 128 patients with clinical suspicion of pneumonia were evaluated; 74 of them were confirmed by imagery and biological inflammatory markers. The highest frequency of pneumonia was in the 0–3 years age group (37.83%). Statistical estimation of the agreement between LUS and CXR in detection of the consolidation found an almost perfect agreement, with a Cohen’s kappa coefficien...
Point-of-care Lung Ultrasound in Pediatric Pneumonia
Pediatric Infectious Disease, 2021
Pneumonia has remained the leading cause of morbidity and mortality in children. Timely diagnosis and prompt treatment can avert many deaths; however, diagnosis of pneumonia in children still remains a challenge. Chest radiography has been widely used worldwide to diagnose pneumonia in children; however, in recent times, lung ultrasound (LUS) is emerging as a useful tool to diagnose pneumonia. The ease of performing LUS, its bedside availability, no exposure to ionizing radiation, and allowance of real-time monitoring of patients make LUS an attractive tool for the intensivists. In this article, we would elaborate the ultrasound equipment, the technique, normal artifacts, and various sonographic patterns of pneumonia in children. The LUS features of various complications of pneumonia like pleural effusion and pneumothorax will also be discussed. This article also summarizes the current evidence of using LUS in the diagnosis of pediatric pneumonia along with the strengths and limitations of this technique.
Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children
Respiratory Medicine, 2015
Lung ultrasound (LUS) is as an easily accessible, radiation-free imaging technique that might be used as a diagnostic tool in community-acquired pneumonia (CAP). The aim of the study was to evaluate the usefulness and accuracy of LUS in the diagnosis and monitoring of childhood CAP. One hundred six consecutive children aged between 1 and 213 (median 52.5) months referred to the hospital with suspicion of CAP were enrolled. All patients underwent LUS on the day of admission, followed by chest radiograph (CXR). Lung ultrasound was also performed in 25 children between 5th-7th and 31 children between 10th-14th day after admission. Radiographic signs of pneumonia were demonstrated in 76 children, while lung ultrasound revealed pulmonary abnormalities consistent with pneumonia in 71 children. LUS gave false negative results in 5 patients with parahilar pulmonary infiltrates demonstrated by CXR. Almost perfect overall agreement between LUS and CXR was found in terms of pneumonia diagnosis (Cohen kappa coefficient of 0.89). The diagnostic performance of LUS in demonstration of lung involvement was as follows: sensitivity of 93.4%, specificity of 100%, positive predictive value of 100%, negative predictive value of 85.7% and accuracy of 95.3%. Our study showed that LUS is a sensitive and highly specific diagnostic method in children with CAP. Therefore, LUS may be considered as the first imaging test in children with suspicion of CAP. A diagnostic algorithm of CAP which includes LUS should be validated in prospective studies. Lung ultrasound can also be used to follow-up resolution of pneumonic lesions.
Performance of chest ultrasound in pediatric pneumonia
European Journal of Radiology, 2017
Objective: The objective of this study was to evaluate the performance of ultrasound in detecting lung consolidation in children suspected of pneumonia, in comparison to the current gold standard, chest X-rays. Materials and methods: From September 2013 to June 2014, a monocentric prospective study was performed on all children between 0 and 16 years-old, referred for chest X-ray for suspected pneumonia. Each child was examined by chest ultrasound by an examiner blinded to the chest X-ray. The presence or absence of areas of consolidation, their number and location were noted for each technique. The size of the consolidations identified only on ultrasound was compared with that of consolidations visible on both techniques. Results: 143 children (mean age 3 years; limits between 8 days and 14 years) were included. Ultrasound detected at least one area of consolidation in 44 out of 45 patients with positive X-rays. Of the 59 areas of consolidation on X-ray, ultrasound identified 54. In the 8 patients with negative X-ray, ultrasound revealed 17 areas of consolidation. The mean size of consolidations visible only on ultrasound was 9.4 mm; for consolidations visible on both techniques the mean size was 26 mm (p < 0.0001). The sensitivity and specificity of ultrasound were calculated at 98% and 92%. PPV and NPV were 85% and 99%, respectively. Conclusion: Chest ultrasound is a fast, non-ionizing and feasible technique. With its high negative predictive value, it can replace X-rays in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.
North American Academic Research, 2022
Pneumonia is a major cause of illness and mortality in children all over the world, but diagnosing it can be difficult, particularly in places without access to trained doctors or conventional imaging. We wanted to know how well lung ultrasonography could diagnose clinical pediatric pneumonia when compared to radiographically proven pneumonia. Between May 1, 2017 and April 30, 2018, we enrolled 2-59-month-olds with primary respiratory symptoms at the Janaki Medical College and Teaching Hospital (JMCTH), Janakpur Dham, Nepal. All subjects got a pediatrician's exam and a GP's lung ultrasound. We enrolled consecutively healthy children. Children with respiratory complaints were x-rayed. A fraction underwent auxiliary lab tests.453 children had pneumonia, 133 asthma, 103 bronchiolitis, and 143 upper respiratory infections. 191 (42%) of 453 children with clinical pneumonia had CXR confirmation. A consolidation on lung ultrasonography, our key outcome for pneumonia, exhibited 88.5% sensitivity, 100% specificity, and an area under-the-curve of 0.94 (95 percent CI 0.92-0.97). When lung ultrasound abnormalities were compared to radiographically-confirmed clinical pneumonia, sensitivity improved to 92.2% and specificity declined to 95.2%, with an AUC of 0.94 (95% CI 0.91-0.96). This study provides further evidence that LUS has a higher diagnostic accuracy than CXR for identifying acute pneumonia. Nevertheless, the accuracy of PLUS, which is a diagnostic tool that is easy to use and is generated from biomarkers, was greater to that of LUS independent of the degree to which patients were fragile.
2020
Background: Pneumonia remains a major cause of morbidity and mortality in childhood with a higher burden in developing countries. Diagnosis relies on clinical findings with supporting evidence from chest X-ray (CXR) and occasionally chest computed tomography (CT). Aim of the work: The aim of this study was to assess the role of lung ultrasonography (LUS) for bedside diagnosis of pediatric pneumonia in comparison to chest CT as a gold standard. Methods: The study was performed on 50 children admitted to Cairo University Children’s Hospitals. All children presented with the classical clinical picture of pneumonia and did CXR, LUS and chest CT. Results: Radiological findings demonstrated lung consolidation in 48 patients (96%) by CXR, 49 (98%) patients by LUS and all 50 patients (100%) by CT chest. Pleural effusion was found in 8 (16%) patients by CT chest, all of which were detected by LUS (100%), but only 5 were correctly detected by CXR (specificity 62.5%) in addition to 3 false pos...