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Arch Dis Child. 2019 Jan;104(1):12-18. doi: 10.1136/archdischild-2017-314496. Epub 2018 Jun 7.

Prospective observational study of point-of-care ultrasound for diagnosing pneumonia.

Author information

1
Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
2
Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
3
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
4
Medical Imaging Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.
5
Emergency Point-of-Care Ultrasound Program, Hospital for Sick Children, Toronto, Ontario, Canada.
6
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
7
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
8
Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.

Abstract

OBJECTIVES:

The clinical diagnosis of pneumonia lacks specificity and may lead to antibiotic overuse, whereas radiological diagnoses can lack sensitivity. Point-of-care lung ultrasound is an emerging diagnostic tool. There are limited prospective data, however, on the accuracy of sonologists in the paediatric emergency department setting. We aimed to test the diagnostic accuracy of lung ultrasound for pneumonia using chest radiograph (CR) as the reference standard.

METHODS:

This prospective observational cohort study in a paediatric emergency department enrolled children aged 1 month to <18 years, who had a CR ordered for possible pneumonia. Lung ultrasounds were performed by two blinded sonologists with focused training. Sonographic pneumonia was defined as lung consolidation with air bronchograms. Radiograph and ultrasound results both required agreement between two readers, with final results determined by an arbiter in cases of disagreement. Patient management was decided by treating clinicians who were blinded to lung ultrasound results. Follow-up was performed by phone and medical record review to obtain final diagnosis and antibiotic use.

RESULTS:

Of 97 included patients, CR was positive for pneumonia in 44/97 (45%) and lung ultrasound was positive in 57/97 (59%). Ultrasound sensitivity was 91% (95% CI 78% to 98%) and specificity was 68% (95% CI 54% to 80%). Ultrasound results displayed greater consistency with CR and patient outcomes when sonographic consolidation exceeded 1 cm. Thirteen of 57 patients with sonographic consolidation improved without antibiotics.

CONCLUSION:

Lung ultrasound may have a role as first-line imaging in patients with possible pneumonia, with higher specificity for consolidations exceeding 1 cm.

TRIAL REGISTRATION NUMBER:

ACTRN12616000361404, http://www.ANZCTR.org.au/ACTRN12616000361404.aspx.

KEYWORDS:

lung; paediatric emergency medicine; pneumonia; point-of-care testing; ultrasonography

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