Point-of-Care Lung Ultrasound in Children with Community Acquired Pneumonia

SONOSIM SUMMARY: This observational study evaluated the utility of point-of-care ultrasound as a tool for the accurate diagnosis of pediatric community acquired pneumonia (CAP).  Ultrasound findings were compared to chest x-ray findings, the current gold-standard for assessing pediatric patients for CAP. Lung ultrasound findings were compatible with pneumonia in 95.3% of confirmed cases, while chest X-ray findings were compatible with pneumonia in 88.5% of confirmed cases. The study supports that point-of-care lung ultrasound is at least as useful as chest x-ray to diagnose pediatric CAP.

Yilmaz H, Ozkaya A, Gokay S, et al. Point‐of‐care lung ultrasound in children with community acquired pneumonia. American Journal of Emergency Medicine 35 (2017) 964-969

Abstract

Objectives
To present lung ultrasound findings in children assessed with suspected pneumonia in the emergency department and to show the benefit of lung ultrasound in diagnosing pneumonia in comparison with chest X-rays.

Methods
This observational prospective study was performed in the pediatric emergency department of a single center. Point of care lung ultrasound was performed on each child by an independent sonographer blinded to the patient’s clinical and chest X-ray findings. Community acquired pneumonia was established as a final diagnosis by two clinicians based on the recommendations in the British Thoracic Society guideline.

Results
One hundred sixty children with a mean age of 3.3 ± 4 years and a median age of 1.4 years (min–max 0.08–17.5 years) were investigated. Final diagnosis in 149 children was community-acquired pneumonia. Lung ultrasound findings were compatible with pneumonia in 142 (95.3%) of these 149 children, while chest X-ray findings were compatible with pneumonia in 132 (88.5%). Pneumonia was confirmed with lung ultrasound in 15 of the 17 patients (11.4%) not evaluated as compatible with pneumonia at chest X-ray. While pneumonia could not be confirmed with lung ultrasound in seven (4.6%) patients, findings compatible with pneumonia were not determined at chest X-ray in two of these patients. When lung ultrasound and chest X-ray were compared as diagnostic tools, a significant difference was observed between them (p = 0.041).

Conclusions
This study shows that lung ultrasound is at least as useful as chest X-ray in diagnosing children with community-acquired pneumonia.

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SonoSim Keywords: Ultrasound Education, Ultrasound Training, Pneumonia