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2017 ; 128
(ä): 57-64
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Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in
low resource settings
#MMPMID28610670
Ellington LE
; Gilman RH
; Chavez MA
; Pervaiz F
; Marin-Concha J
; Compen-Chang P
; Riedel S
; Rodriguez SJ
; Gaydos C
; Hardick J
; Tielsch JM
; Steinhoff M
; Benson J
; May EA
; Figueroa-Quintanilla D
; Checkley W
Respir Med
2017[Jul]; 128
(ä): 57-64
PMID28610670
show ga
BACKGROUND: Pneumonia is a leading cause of morbidity and mortality in children
worldwide; however, its diagnosis can be challenging, especially in settings
where skilled clinicians or standard imaging are unavailable. We sought to
determine the diagnostic accuracy of lung ultrasound when compared to
radiographically-confirmed clinical pediatric pneumonia. METHODS: Between January
2012 and September 2013, we consecutively enrolled children aged 2-59 months with
primary respiratory complaints at the outpatient clinics, emergency department,
and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru.
All participants underwent clinical evaluation by a pediatrician and lung
ultrasonography by one of three general practitioners. We also consecutively
enrolled children without respiratory symptoms. Children with respiratory
symptoms had a chest radiograph. We obtained ancillary laboratory testing in a
subset. RESULTS: Final clinical diagnoses included 453 children with pneumonia,
133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory
infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children
with clinical pneumonia. A consolidation on lung ultrasound, which is our primary
endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an
area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to
radiographically-confirmed clinical pneumonia. When any abnormality on lung
ultrasound was compared to radiographically-confirmed clinical pneumonia the
sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an
area under-the-curve of 0.94 (95% CI 0.91-0.96). CONCLUSIONS: Lung ultrasound had
high diagnostic accuracy for the diagnosis of radiographically-confirmed
pneumonia. Added benefits of lung ultrasound include rapid testing and high
inter-rater agreement. Lung ultrasound may serve as an alternative tool for the
diagnosis of pediatric pneumonia.