Point-of-care US bests stethoscope for pediatric pneumonia diagnosis

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 - sick child

Clinicians provided with one hour of focused training in the use of ultrasound to diagnose pneumonia in children were able to diagnose the condition with high specificity, according to a study published online Dec. 10 in the Archives of Pediatrics & Adolescent Medicine.

Pneumonia remains the leading cause of death in children worldwide. Although chest x-ray is the diagnostic exam of choice for diagnosis, as many as three-fourths of the world’s population lack access to diagnostic imaging, according to the World Health Organization.

Auscultation by stethoscope and clinical exam findings can be unreliable in the diagnosis of pneumonia. Specifically, diagnosing pneumonia with a stethoscope can be more difficult when a patient is wheezing or has co-existing diseases like asthma or bronchiolitis. At the same time, point-of-care ultrasound technology has become more widely available and previous studies have suggested its feasibility and accuracy in the diagnosis of pneumonia.

Vaishali P. Shah, MD, from the department of emergency medicine, Children’s Hospital at Montefiore in New York City, and colleagues designed a prospective observational cohort study to determine the accuracy of point-of-care ultrasound for the diagnosis of pneumonia in children and young adults. Chest x-ray served as a reference standard.

The researchers enrolled 200 patients (median age, 3 years) in the study and completed a subgroup analysis of patients with lung consolidation exceeding 1 cm with sonographic air bronchograms. Clinicians were provided with one hour of focused ultrasound training in the use of ultrasound to diagnose pneumonia.

A total of 36 patients were positive for pneumonia based on chest x-ray, and 49 patients were identified as having pneumonia by ultrasound exam. Thirty-six of these patients had lung consolidations exceeding 1 cm. The researchers calculated 86 percent sensitivity and 89 percent specificity for any positive ultrasound finding and 86 percent sensitivity and 97 percent specificity for lung consolidation with sonographic air bronchograms exceeding 1 cm only.

Mean ultrasound exam time was seven minutes for all clinicians, and eight minutes for clinicians with less experience (25 or fewer ultrasound exams).

“Based on our data, ultrasonography is more specific (accurate ruling in) than sensitive (accurate ruling out) for pneumonia and is more accurate than overall clinical impression, auscultation and World Health Organization-defined tachypnea,” wrote Shah and colleagues.   

The researchers noted the advantages of ultrasound; it can be performed at the point of care, without exposing children to ionizing radiation. Ultrasound can be implemented in remote regions, underserved areas and developing countries.