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J Thorac Dis. 2019 Dec;11(12):5107-5114. doi: 10.21037/jtd.2019.11.62.

Lung ultrasonography versus chest radiography for the diagnosis of pediatric community acquired pneumonia in emergency department: a meta-analysis.

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Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China.
Department of Ultrasound, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.



Pediatric community acquired pneumonia (pCAP) is a major public health and economic problem with a considerable impact on morbidity and mortality in children. Recently many studies and meta-analyses have shown promising results on the accuracy of lung ultrasonography (LU) in diagnosing pneumonia and potentially replacing chest radiography (CR) in pediatric population. However, previous studies establishing the accuracy of LU often used CR as reference standard and took into account different clinical settings all together. To make a more objective and specific analysis, we performed a systematic review and meta-analysis to compare the diagnostic accuracy of LU and CR for pCAP in the emergency department (ED) setting.


A literature search of PubMed and Embase databases up to December 2018 was conducted. Pooled sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio of LU and CR were calculated, and summary receiver operating characteristic (SROC) curves were drawn.


A total of six studies, which included 575 pCAPs from 701 patients, were finally analyzed. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratios of LU were 96.7%, 87.3%, 8.10, 0.05, 256.68, while they were 89.7%, 93.7%, 9.97, 0.12, 175.07 for CR, respectively. The area under the SROC curves in diagnosing pCAP in the ED setting were 0.99 [95% confidence interval (CI), 0.98-1.00] and 0.97 (95% CI, 0.95-1.00) for LU and CR, respectively.


Our meta-analysis suggests that LU is an accurate tool in the diagnosis of pCAP in the ED setting with a superior sensitivity over CR.


Lung ultrasonography (LU); chest radiography (CR); emergency department (ED); pediatric community acquired pneumonia (pCAP)

Conflict of interest statement

Conflicts of Interest: The authors declare that they have no conflicts of interest.

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