Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis

Abstract

BackgroundClinical assessment is the gold standard for diagnosis of bronchiolitis. To date, only one study found LUS (Lung Ultrasound) to be a valuable tool in the diagnosis of bronchiolitis. Aim of this study is to evaluate the accuracy of lung ultrasonography in the diagnosis and management of bronchiolitis in infants.MethodsThis was an observational cohort study of infants admitted to our Pediatric Unit with suspected bronchiolitis. A physical examination and lung ultrasound scans were performed on each patient. Diagnosis and grading of bronchiolitis was assessed according to a clinical and a ultrasound score. An exploratory analysis was used to assess correspondence between the lung ultrasound findings and the clinical evaluation and to evaluate the inter-observer concordance between the two different sonographs.ResultsOne hundred six infants were studied (average age 71 days). According to our clinical score, 74 infants had mild bronchiolitis, 30 had moderate bronchiolitis and two had severe bronchiolitis. 25 infants composed the control group. Agreement between the clinical and sonographic diagnosis was good (90.6 %) with a statistically significant inter-observer ultrasound diagnosis concordance (89.6 %).Lung ultrasound permits the identification of infants who are in need of supplementary oxygen with a specificity of 98.7 %, a sensitivity of 96.6 %, a positive predictive value of 96.6 % and a negative predictive value of 98.7 %. An aberrant ultrasound lung pattern in posterior chest area was collected in 86 % of infants with bronchiolitis. In all patients clinical improvement at discharge was associated with disappearance of the previous LUS findings. Subpleural lung consolidation of 1 cm or more in the posterior area scan and a quantitative classification of interstitial syndrome based on intercostal spaces involved bilaterally, good correlate with bronchiolitis severity and oxygen use.ConclusionsThe lung ultrasound findings strictly correlate with the clinical evaluations in infants with bronchiolitis and permit the identification of infants who are in need of supplementary oxygen with high specificity. Scans of the posterior area are more indicative in ascertaining the severity of bronchiolitis.Trial registrationClinical Trial Registration NCT01993797

Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze

“…This proportion is markedly lower than the proportions reported in the only two bronchiolitis studies published to date, each with proportions of a positive LUS ≥90% 18 19. However, direct comparison may not be possible owing to the characteristics of the populations studied: ours being primarily outpatient versus both other studies were on admitted children with seemingly more severe illness severities.…”

“…Moreover, compared with physical exam in the PED, LUS performed with a greater diagnostic accuracy than any single or combined clinical finding for pneumonia 17. Most recently, two studies have explored the utility of LUS in hospitalised children with bronchiolitis; findings included a correlation between the number of LUS findings and illness severity,18 19 a decreased number of LUS findings with disease resolution19 and LUS accurately predicted the need for oxygen therapy among admitted children 18…”

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

“…In studies performed in children with a diagnosis of bronchiolitis or viral pneumonia, ultrasound findings consisted of small sub-pleural consolidations (typically 0.25 cm in depth) with associated pleural line abnormalities, single or confluent B lines [6, 195, 196]. In general, the presence of more sonographic findings in the lungs correlated with more severe bronchiolitis/viral pneumonia [195], and the need for supplemental oxygen [6]. These ultrasound findings were helpful in distinguishing bacterial versus viral pneumonia during the H1N1 influenza A epidemic in 2009 with high inter-observer agreement [196].…”

“…Pediatric emergency POCUS has been part of this movement, with published scanning protocols describing its use in the evaluation of trauma, abdominal pain [4, 5], dyspnea [6], and musculoskeletal complaints [7, 8], among others. This is much the same range of complaints that are the focus of adult emergency and critical care ultrasound.…”

Point‐of‐care lung ultrasound in paediatric critical and emergency care

“…Clinical diagnosis concerning severity of the disease agreed with the sonographic findings in 90.6% of the cases. LUS also allowed the identification of patients needing oxygen support with high specificity (98.7%) and sensitivity (96.6%) . This study enrolled 52 patients with a clinical diagnosis of bronchiolitis and 52 without any signs or symptoms (control group).…”