Stethoscope vs. ultrasound probe - which is more reliable in children with suspected pneumonia?
Jovan Lovrenski1, Slobodanka Petrović2, Svetlana Balj-Barbir3
1Radiology Department, Institute for Children and Adolescents Health Care of Vojvodina, Serbia. jolo221177@gmail.com.
Insights
Lung ultrasound (LUS) detected more pneumonia cases than auscultation in children. Smaller consolidations (<30mm) were less likely to be found by auscultation, highlighting LUS’s diagnostic advantage.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Imaging
- Medical Ultrasound
Background:
- Pneumonia is a common childhood illness requiring accurate diagnosis.
- Clinical assessment using auscultation has limitations in detecting pneumonia.
- Lung ultrasound (LUS) offers a non-invasive imaging modality for evaluating pediatric respiratory conditions.
Purpose of the Study:
- To compare the diagnostic accuracy of lung ultrasound (LUS) against auscultation in children with suspected pneumonia.
- To evaluate the correlation between lung ultrasound findings and auscultatory signs in pediatric pneumonia.
Main Methods:
- Prospective study of 95 children (2 months–17.5 years) with suspected pneumonia.
- Simultaneous lung ultrasound (LUS) and auscultation performed by blinded radiologist and clinician.
- Comparison of findings per hemithorax; measurement of subpleural consolidation cranio-caudal diameter.
Main Results:
- Lung ultrasound (LUS) identified pneumonia-positive findings in more hemithoraces (98) compared to auscultation (64).
- Statistically significant differences were observed between LUS and auscultation findings (McNemar's test, p<0.05).
- Subpleural consolidations <30mm cranio-caudal diameter were significantly less likely to be detected by auscultation.
Conclusions:
- Lung ultrasound (LUS) demonstrates superior sensitivity in detecting pneumonia in children compared to traditional auscultation.
- The size of subpleural consolidation is a critical factor influencing the detectability of pneumonia by auscultation.
- LUS is a valuable tool for diagnosing pediatric pneumonia, especially for smaller consolidations missed by auscultation.
Objective:
To compare lung ultrasound (LUS) with auscultation findings in children with clinical suspicion of pneumonia.
Patients And Methods:
A prospective study including 95 patients (age: from 2 months to 17.5 years; mean age: 5.1 y, SD 4.5 y) with referral diagnosis of suspected pneumonia. In all patients LUS and auscultatory examinations were performed within an hour. These findings were compared separately in each hemithorax. The radiologist performing LUS was blinded to the patient's clinical information. Positive auscultatory findings included: crackles and/or abnormal breath sounds (decreased, asymmetric, absent, or bronchial). For LUS examinations a combined transthoracic - transabdominal approach was used. A pneumonia-positive LUS finding included subpleural consolidation with air-bronchogram, or an adjacent area of interstitial edema. For each subpleural consolidation the cranio-caudal (CC) diameter was measured, and 95% confidence intervals (CI) of the sizes of subpleural consolidations for positive and negative auscultatory findings were compared. The p-value between LUS and auscultation was calculated using McNemar's test.
Results:
LUS and auscultation showed pneumonia-positive findings in 98 and 64 hemithoraces, i.e. in 67 and 45 patients respectively. In positive auscultatory findings the CI for CC diameters of subpleural consolidations ranged from 32.46 to 54.14 mm, and in negative auscultatory findings the CI was between 16.52 and 29.83 mm, which showed a statistically significant difference. McNemar's test showed a statistically significant difference between LUS and auscultation.
Conclusions:
LUS showed positive findings in more hemithoraces than auscultation in children with suspected pneumonia. A cranio-caudal size of subpleural consolidation of less than 30 mm significantly reduces the possibility of auscultatory detection.
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