Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings (original) (raw)
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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.
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.
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 ...
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...
Serial lung ultrasounds in pediatric pneumonia in Mozambique and Pakistan
Scientific Reports, 2021
Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing and managing pneumonia. We sought to explore serial LUS examinations in children with chest-indrawing pneumonia in resource-constrained settings and compare their clinical and LUS imaging courses longitudinally. We conducted a prospective, observational study among children aged 2 through 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at 2 district hospitals in Mozambique and Pakistan. We assessed serial LUS at enrollment, 2, 6, and 14 days, and performed a secondary analysis of enrolled children’s longitudinal clinical and imaging courses. By Day 14, the majority of children with chest-indrawing pneumonia and consolidation on enrollment LUS showed improvement on follow-up LUS (100% in Mozambique, 85.4% in Pakistan) and were clinically cured (100% i...
Lung, 2015
Purpose The World Health Organization (WHO) case management algorithm for acute lower respiratory infections has moderate sensitivity and poor specificity for the diagnosis of pneumonia. We sought to determine the feasibility of using point-of-care ultrasound in resource-limited settings to identify pneumonia by general health practitioners and to determine agreement between the WHO algorithm and lung consolidations identified by point-of-care ultrasound. Methods An expert radiologist taught two general practitioners how to perform point-of-care ultrasound over a seven-day period. We then conducted a prospective study of children aged 2 months to 3 years in Peru and Nepal with and without respiratory symptoms, which were evaluated by point-of-care ultrasound to identify lung consolidation. Results We enrolled 378 children: 127 were controls without respiratory symptoms, 82 had respiratory symptoms without clinical pneumonia, and 169 had clinical pneumonia by WHO criteria. Point-of-care ultrasound was performed in the community (n = 180), in outpatient offices (n = 95), in hospital wards (n = 19), and in Emergency Departments (n = 84). Average time to perform point-of-care ultrasound was 6.4 ± 2.2 min. Inter-observer agreement for point-of-care ultrasound interpretation between general practitioners was high (j = 0.79, 95 % CI 0.73-0.81). The diagnosis of pneumonia using the WHO algorithm yielded a sensitivity of 69.6 % (95 % CI 55.7-80.8 %), specificity of 59.6 % (95 % CI 54.0-65.0 %), and positive and negative likelihood ratios of 1.73 (95 % CI 1.39-2.15) and 0.51 (95 % CI 0.30-0.76) when lung consolidation on point-of-care ultrasound was used as the reference. Conclusions The WHO algorithm disagreed with pointof-care ultrasound findings in more than one-third of children and had an overall low performance when compared with point-of-care ultrasound to identify lung consolidation. A paired approach with point-of-care ultrasound may improve case management in resource-limited settings.
Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis
Pediatrics, 2015
BACKGROUND AND OBJECTIVE: Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia. Literature of studies comparing LUS diagnostic accuracy against a reference standard. We used a combination of controlled key words for age ,18 years, pneumonia, and ultrasound. We identified 1475 studies and selected 15 (1%) for further review. Eight studies (765 children) were retrieved for analysis, of which 6 (75%) were conducted in the general pediatric population and 2 (25%) in neonates. Eligible studies provided information to calculate sensitivity, specificity, and positive and negative likelihood ratios. Heterogeneity was assessed by using Q and I 2 statistics.
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.
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.