Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children

Abstract

Lung ultrasound (LUS) is as an easily accessible, radiation-free imaging technique that might be used as a diagnostic tool in community-acquired pneumonia (CAP). The aim of the study was to evaluate the usefulness and accuracy of LUS in the diagnosis and monitoring of childhood CAP. One hundred six consecutive children aged between 1 and 213 (median 52.5) months referred to the hospital with suspicion of CAP were enrolled. All patients underwent LUS on the day of admission, followed by chest radiograph (CXR). Lung ultrasound was also performed in 25 children between 5th-7th and 31 children between 10th-14th day after admission. Radiographic signs of pneumonia were demonstrated in 76 children, while lung ultrasound revealed pulmonary abnormalities consistent with pneumonia in 71 children. LUS gave false negative results in 5 patients with parahilar pulmonary infiltrates demonstrated by CXR. Almost perfect overall agreement between LUS and CXR was found in terms of pneumonia diagnosis (Cohen kappa coefficient of 0.89). The diagnostic performance of LUS in demonstration of lung involvement was as follows: sensitivity of 93.4%, specificity of 100%, positive predictive value of 100%, negative predictive value of 85.7% and accuracy of 95.3%. Our study showed that LUS is a sensitive and highly specific diagnostic method in children with CAP. Therefore, LUS may be considered as the first imaging test in children with suspicion of CAP. A diagnostic algorithm of CAP which includes LUS should be validated in prospective studies. Lung ultrasound can also be used to follow-up resolution of pneumonic lesions.

Performance of lung ultrasonography for the diagnosis of communityacquired pneumonia in hospitalized children

“…In our study, LUS also performed better than chest radiography for the detection of pleural effusion -10 additional cases with pleural effusion were identified by LUS. Similar results of a higher performance of LUS in the identification of pleural effusion when compared to chest radiographs have been previously reported, with LUS identifying effusion in 54.3% of the patients and chest radiographs in only 12.1% of the patients [19].…”

“…In a prospective study published by Urbanowska et al [19], LUS had a sensitivity of 93.4% and PPV of 95.3% in identification of lung involvement. The study enrolled 106 consecutive children between 1 and 213 months of age, with a suspicion of community-acquired pneumonia, and the diagnosis was performed based on the presence of clinical criteria and at least one radiographic criterion (consolidation, parenchymal infiltrates, linear and patchy Table II.…”

“…Urbanowska et al [19] showed a high agreement between LUS and chest radiographs, with a Cohen kappa coefficient of agreement of 0.89. Esposito et al [15] also found a high accuracy of LUS as compared to chest radiographs, with a sensitivity of 97.9% and a specificity of 94.5%.…”

“…Previous studies performed both in children and adults have shown that LUS is not inferior to chest radiographs in identifying lung abnormalities in patients with a clinical suspicion of pneumonia [15,16,18,19,[21][22][23][24]. Urbanowska et al [19] showed a high agreement between LUS and chest radiographs, with a Cohen kappa coefficient of agreement of 0.89.…”

“…Its purpose is to support the diagnosis and the ultrasonographical findings, positive or negative, should be interpreted in the context of clinical findings. Previous individual prospective studies enrolling children with suspicion of pneumonia and in which the diagnosis of pneumonia was established using clinical criteria alone or clinical criteria in combination with radiographic findings have reported higher values of specificity, ranging between 96% and 100% and NPV of 95.7% [19,20]. The above mentioned meta-analysis which included all available prospective studies in which the confirmation of pneumonia was performed by a combination of clinical findings and chest radiographs or chest CT scan, showed a specificity of LUS of 93% (95%CI: 89.6-95.6) [8].…”