Accuracy of lung ultrasonography in diagnosis of community acquired pneumonia in hospitalized children as compared to chest x-ray

Authors

  • Prahlad R. Tirdia Department of Pediatrics, SPMCHI, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan
  • Shailja Vajpayee Department of Pediatrics, SPMCHI, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan
  • Jagdish Singh Department of Pediatrics, SPMCHI, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan
  • RK Gupta Department of Pediatrics, SPMCHI, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan

DOI:

https://doi.org/10.18203/2349-3291.ijcp20162385

Keywords:

Lung ultrasound, Chest x-ray, Radiation, Imaging tool, Consolidation

Abstract

Background: The ultrasound signs of lung and pleural diseases described in adults are also found in pediatric patients. LUS is at least as accurate as chest radiography in diagnosing pneumonia. The objective of the study was to define the lung ultrasonography (LUS) characteristics at presentation and follow up of hospitalized children with community acquired pneumonia (CAP) and to define the accuracy of LUS as compared to chest X-ray (CXR) in diagnosing CAP.

Methods: It was a hospital based prospective study done at department of paediatrics, SMS hospital, Jaipur. A total of 139 children between 2 months to 18 years of age admitted in hospital with diagnosis of CAP who fulfilled the inclusion and exclusion criteria were included in the study after obtaining informed written consent. Clinical driven CXR was done on day of the admission. LUS was done in all patients. The LUS findings obtained were compared with those of CXR. The data was analyzed by using standard statistical methods.

Results: Of 139 patients, LUS characteristically shows sub pleural consolidation (absolute consolidation or with other findings) in 93.5 % (130/139), confluent B-lines abnormalities 35.9 % (50/139), pleural line abnormalities in 17.2% (24/139), and pleural effusion in 15.8 % (22/139) patients, while LUS was indicative of pneumonia in 136 (97.84%), CXR was suggestive of pneumonia in 126 (90.64%) patients (p <0.01). The LUS had sensitivity of 97.84%. Consolidation was reported in 130 (93.53%) patients by LUS as compared to 107 (76.97%) patients by CXR (p<0.001). During follow up, LUS in seven patient initially showed increase in size of consolidation consistent with clinical deterioration then gradual decrease in size of consolidation due change in antibiotics.

Conclusions: LUS was highly accurate for the diagnosis as well as for follow up of CAP in hospitalized children. It avoids the use of ionizing radiation. Therefore, the use of ultrasound needs to be encouraged not just as a valid diagnostic alternative but as a necessary ethical choice.

 

References

Rudan I, Tomaskovic L, Boschi PC, Campbell H. WHO Child Health Epidemiology Reference Group. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004;82(12):895-903.

World Health Organization Pneumonia Fact sheet (November 2013): www.who.int/mediacentre/ factsheets/fs331.

Harris M, Clark J, Coote N. British Thoracic Society guidelines for the management of community acquired pneumonia in children. Thorax. 2011;66(Suppl 2):ii1-23.

Shah S, Bachur R, Kim D, Neuman MI. Lack of predictive value of tachypnea in the diagnosis of pneumonia in children. Pediatric Infectious Disease Journal. 2010;29(5):406-9.

Park MY, Jung SE. Patient Dose Management: Focus on Practical Actions. Journal of Korean Medical Science. 2016;31(Suppl 1):S45-54.

Gargani L, Picano E.The risk of cumulative radiation exposure in chest imaging and the advantage of bedside ultrasound. Critical Ultrasound Journal. 2015;7:4.

Williams GJ, Macaskill P, Kerr M. Variability and accuracy in interpretation of consolidation on chest radiography for diagnosing pneumonia in children under 5 years of age. Pediatr Pulmonol. 2013;48(12):1195-200.

Wingerter SL, Bachur RG, Monuteaux MC, Neuman MI. Application of the world health organization criteria to predict radiographic pneumonia in a US-based pediatric emergency department. Pediatr Infect Dis J. 2012;31(6):561-4.

Solomon SD, Saldana F. Point-of-care ultrasound in medical education-stop listening and look. N Engl J Med. 2014;370(12):1083-5.

Chavez MA, Shams N, Ellington LE. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.

Ye X, Xiao H, Chen B, Zhang S. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community- Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS One. 2015;10(6):e0130066.

Chen SW, Zhang MY, Liu J. Application of Lung Ultrasonography in the Diagnosis of Childhood Lung Diseases. Chinese Medical Journal. 2015;128(19):2672-8.

Cattarossi L. Lung ultrasound: its role in neonatology and pediatrics. Early Hum Dev. 2013;89(Suppl 1):S17-9.

Zimmerman DR, Kovalski N, Fields S, Lumelsky D, Miron D. Diagnosis of childhood pneumonia: clinical assessment without radiological confirmation may lead to overtreatment. Pediatr Emerg Care. 2012;28:646-9.

Donnelly LF, Klosterman LA. The yield of CT of children who have complicated pneumonia and non-contributory chest radiography. AJR Am J Roentgenol. 1998;170(6):1627-31.

Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB. The air bronchogram: sonographic demonstration. American Journal of Roentgenology. 1986;147:593-5.

Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children. Radiol Med (Torino). 2008;113(2):190-8.

Iuri D, De Candia A, Bazzocchi M. Evaluation of the lung in children with suspected pneumonia: usefulness of ultrasonography. Radiol Med (Torino). 2009;114(2):321-30.

Shah VP, Tunik MG, Tsung JW. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. 2013;167(2):119-25.

Ho MC, Ker CR, Hsu JH, Wu JR, Dai ZK, Chen IC. Usefulness of lung ultrasound in the diagnosis of community-acquired pneumonia in children. Pediatrics and Neonatology. 2015;56(1):40-5.

Pereda MA, Chavez MA, Hooper-Miele CC. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015;135(4):714-22.

Caiulo VA, Gargani L, Caiulo S, et al. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol. 2013;48(3):280-7.

Ianniello S, Piccolo CL, Buquicchio GL, Trinci M, and Miele V. First-line diagnosis of pediatric pneumonia in emergency: lung ultrasound (LUS) in addition to chest-X-ray and its role in follow-up. The British Journal of Radiology. 2016;89:1061.

Reali F, Sferrazza Papa GF, Carlucci P, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children? Respiration. 2014;88(2):112-5.

Reissig A, Copetti. Lung ultrasound in community-acquired pneumonia and in interstitial lung diseases. Respiration. 2014;87(3):179-89.

King S, Thomson A. Radiological perspectives in empyema. Br Med Bull. 2002;61:203-14.

Tsung JW, Kessler DO, Shah VP. Prospective application of clinician-performed lung ultrasonography during the 2009 H1N1 influenza A pandemic: distinguishing viral from bacterial pneumonia. Crit Ultrasound J. 2012;4(1):16.

Kurian J, Levin TL, Han BK, Taragin BH, Weinstein S. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 2009;193(6):1648-54.

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Published

2016-12-21

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Original Research Articles