Ultrasonography of the Lungs and Pleurae for the Diagnosis of Pneumonia in Children Prime Time for Routine Use Ultrasonography of the Lungs and Pleurae

Darge K, Chen A. — Fri, 01 Feb 2013 00:00:00 GMT

The above title sounds rather paradoxical when one realizes that the use of ultrasonography (USG) for the diagnosis of pneumonia had been reported as early as 1970. A quarter century has also passed since the first study was published that encompassed a large group of children. In that study, Weinberg et al described in detail the sonographic findings of the air bronchograms of 30 pediatric patients diagnosed with pneumonia. However, it is just in recent years that the pediatric community is becoming increasingly aware of the utility of this method, particularly in the setting of point-of-care USG.

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

Shah VP, Tunik MG, Tsung JW. — Fri, 01 Feb 2013 00:00:00 GMT

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: Ultrasonography Topic Collection

Ultrasonography of the Lungs and Pleurae for the Diagnosis of Pneumonia in Children Prime Time for Routine Use Ultrasonography of the Lungs and Pleurae

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