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Lung ultrasounds reliably detect pneumonia in children
Lung ultrasounds were an effective alternative to chest radiography for the diagnosis of pneumonia in children, according to recent study data.
“Advances in ultrasound technology have made lung ultrasound (LUS) an attractive option for the diagnosis of pneumonia,” the researchers wrote. “Moreover, ultrasound is safe, portable, inexpensive and relatively easy to teach.”
An international meta-analysis of eight studies compared the accuracy of LUS against chest radiography (CR) and/or clinical criteria, and weighed the positive and negative likelihood ratios. The cohort included 765 patients aged 18 years and younger.
Eighty-eight percent of the studies used CR as standard practice, and 63% used clinical criteria and CR. Each study performed LUS after chest imaging.
Clinicians performed chest CT scans in 38% of the studies for clinical purposes. Thirteen percent were used to identify pneumonia in four patients who had inconsistent chest radiography and LUS results. In those outcomes, chest CT results were consistent with LUS findings and not with CR.
The analysis showed high sensitivity (96%; 95% CI, 94-97) and specificity (93%; 95% CI, 90-95.7) using LUS. A positive likelihood ratio of 15.3 (95% CI, 6.6-35.3) and negative likelihood ratio of 0.06 (95% CI, 0.03-0.11) indicated that LUS was accurate in diagnosing pneumonia in children (area under the ROC curve, 0.98; 95% CI, 0.96-1). Heterogeneity, however, was detected throughout the studies (I² > 0.45).
“Despite significant heterogeneity across studies, LUS performed well for the diagnosis of pneumonia in children,” the researchers wrote.
When clinical criteria as a reference standard was eliminated, LUS specificity decreased to 84%, likely showing that CR alone is insufficient in diagnosing pneumonia, according to the researchers.
The researchers also compared the reports conducted by highly trained physicians (63%) vs nonexpert trained physicians. Trained physicians had higher specificity during diagnosis, but nonexperts still had high specificity and sensitivity.
“Although the sensitivity and specificity are best in the hands of expert users, our study provides evidence of good diagnostic accuracy even in the hands of nonexperts,” the researchers concluded. “Recommendations to train general pediatricians on LUS for the diagnosis of childhood pneumonia may have an important impact in different clinical settings, especially in resource-poor countries and small primary care clinics where CR may not be commonly available.”
Disclosures: The researchers report no relevant financial disclosures.
