Might lung ultrasound displace x-ray for infants and toddlers with possible pneumonia?

When young children present in the emergency department wheezing and with an evident respiratory tract infection, lung ultrasound does a fine job ruling out asthma and ruling in pneumonia.

The authors of the study behind this finding speculate that, should their work get confirmed in future research, lung ultrasound (LUS) will become a go-to tool for guiding diagnosis and treatment in such scenarios.

Publishing their study in the September edition of Emergency Medicine Journal, Terry Varshney, MD, of Children’s Hospital of Eastern Ontario and colleagues at McGill University describe their work enrolling 94 patients 2 years old and younger (median age, 11.1 months) who were wheezing but not in severe respiratory distress.

A treating physician remained blinded to ultrasound findings, and the researchers later retrieved final diagnoses from the medical record.

The team found that LUS was positive in some 42 percent (39 of 94) of patients, leading them to conclude that the modality could well serve as a point-of-care tool for clinicians to direct the care of young children whose wheeze has no clear cause.  

“For instance, if a 12-month-old with an atopic background presents with rhinorrhea and wheeze,” they write, “a positive LUS would direct the clinician away from an episode of bronchospasm and more towards bronchiolitis and/or pneumonia, whereas a negative LUS may decrease the likelihood of pneumonia.”

The authors further report that most of the children diagnosed with pneumonia, with or without concomitant asthma, had a positive LUS. They note that this consistent with much of the literature on LUS and pneumonia.

Meanwhile, 28 percent of children in the present study were x-rayed.

From this, they write, “it can be conjectured that the use of LUS for the diagnosis of pneumonia would reduce a significant portion of unnecessary radiographs with their inherent radiation exposures, overprescribed antibiotics and related costs.”

LUS, they conclude, “could potentially serve as a point-of-care tool to help rapidly distinguish etiologies in children with wheeze.”

Acknowledging their small sample as a limitation, the authors urge caution in interpreting their results.