Format

Send to

Choose Destination
Respir Med. 2017 Jul;128:57-64. doi: 10.1016/j.rmed.2017.05.007. Epub 2017 May 15.

Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.

Author information

1
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.
2
Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.
3
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.
4
Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.
5
Instituto Nacional de Salud del Niño, Lima, Peru.
6
Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, USA.
7
Unidad de Cuidados Intensivos, Hospital Nacional Eduardo Rebagliati Martins, Lima, Peru.
8
Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, USA.
9
Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington D.C., USA.
10
Global Health Center, Cincinnati Children's Hospital, Cincinnati, USA.
11
Department of Radiology and Radiological Sciences, School of Medicine, Johns Hopkins University, Baltimore, USA.
12
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA; Program in Global Disease Epidemiology and Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. Electronic address: wcheckl1@jhmi.edu.

Abstract

BACKGROUND:

Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia.

METHODS:

Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset.

RESULTS:

Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91-0.96).

CONCLUSIONS:

Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically-confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia.

KEYWORDS:

Lung ultrasound; Pediatric pneumonia; Point-of-care diagnosis

PMID:
28610670
PMCID:
PMC5480773
DOI:
10.1016/j.rmed.2017.05.007
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center