Point‐of‐care lung ultrasound findings in the pediatric emergency clinic during the COVID‐19 pandemic

Abstract

Purpose To describe our experience concerning lung ultrasound (LUS) in the pediatric emergency clinic, and to investigate the diagnostic value of LUS in coronavirus disease‐2019 (COVID‐19). Methods Patients aged under 18 admitted to the pediatric emergency clinic with suspicion of COVID‐19, who underwent point‐of‐care LUS and from whom COVID‐19 reverse transcription polymerase chain reaction (RT‐PCR) samples were collected, were included in the study. Results Point‐of‐care LUS was performed on 74 patients in the emergency room. LUS findings were more sensitive than chest X‐ray in the early stages of the disease and in mild cases. Involvement was observed at LUS despite RT‐PCR being negative in some symptomatic patients with a COVID‐19 contact history. Conclusions We think that LUS can be beneficial in terms of identifying patients with lung involvement and staging their severity in this new disease in pediatric emergency clinics. The procedure is noninvasive, rapid, reproducible, and low cost, involving simple sterilization. Based on the current literature and our own practical experience, we think that increased use of point‐of‐care LUS can protect patients from unnecessary radiation and treatment delays during the COVID‐19 pandemic.

Quantitative assessment of COVID‐19 pneumonia in neonates using lung ultrasound score

“…10 Furthermore, LUS findings are more sensitive than chest Xray in pediatric patients with COVID-19 infection, especially in the early stage of the disease and in mild cases. 17 Since LUS detects the artifacts generated by the accumulation of fluid, we could rank the artifacts according to the air/liquid ratio and create a score reflecting lung aeration. LUSS, a three-stage classification system, could comprehensively and semi-quantitatively reflect the lung aeration function and disease severity.…”

“…According to previous research regarding LUS application in the COVID‐19 pediatric population, when compared with the gold standard of chest CT, chest X‐ray displays false‐negative results for pulmonary involvement in 75%, whereas for LUS it is 16.7% 10 . Furthermore, LUS findings are more sensitive than chest X‐ray in pediatric patients with COVID‐19 infection, especially in the early stage of the disease and in mild cases 17 …”

Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases

“…In particular, specificity was 93.75% and sensibility 83.33%, with a PPV as high as 90.9% [78]. These data suggest that LUS could be used as a screening tool in children with probable SARS-CoV2 symptomatic infection, aiming to determine those with greater lung involvement and higher risk for respiratory support [12,79,80]. Nevertheless, LUS should not be considered a diagnostic tool for COVID-19, as ultrasonographic patterns are non-specific and shared with other respiratory viral infections, such as acute bronchiolitis [81].…”

Lung Ultrasound in Pediatrics and Neonatology: An Update

“…Despite the paucity of studies about this new infection in children (characterized by lower incidence and severity [56]), it appears that sonographic features of pediatric COVID-19 are non-specific and similar to those described in adults: B-lines with a tendency to coalescence; subpleural consolidations associated with pleural line irregularities [57][58][59][60][61]. Moreover, LUS was found to have a higher sensitivity than CXR in the diagnosis of COVID-19 (83.33-88.9% vs. 25-51.9%, respectively), improving early detection [52,62,63].…”