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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Performance of chest ultrasound in pediatric pneumonia
Anne-Sophie Claes1, Philippe Clapuyt2, Renaud Menten2
1Departement of Radiology, Pediatric and Thoracic Radiology Unit, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium.
Insights
Pediatric chest ultrasound effectively detects lung consolidation, showing high sensitivity (98%) and specificity (92%) for pneumonia diagnosis. This non-ionizing imaging can replace chest X-rays, significantly reducing radiation exposure in children.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Pulmonology
Background:
- Pneumonia diagnosis in children often relies on chest X-rays, which involve ionizing radiation.
- Evaluating alternative, non-ionizing imaging modalities is crucial for pediatric patient safety.
- Ultrasound's utility in detecting lung consolidation requires further validation against established methods.
Purpose of the Study:
- To assess the diagnostic performance of ultrasound in identifying lung consolidation in pediatric patients with suspected pneumonia.
- To compare ultrasound findings with chest X-ray results, the current gold standard.
- To evaluate ultrasound's potential to reduce radiation exposure in children.
Main Methods:
- A prospective monocentric study included 143 children (0-16 years) with suspected pneumonia.
- Chest ultrasound was performed by a blinded examiner, comparing findings with chest X-rays.
- Data collected included presence, number, and location of consolidations, and their sizes.
Main Results:
- Ultrasound detected consolidation in 44/45 patients with positive X-rays and identified 54/59 X-ray consolidations.
- Ultrasound revealed 17 consolidations in 8 patients with negative X-rays.
- Ultrasound demonstrated high sensitivity (98%), specificity (92%), PPV (85%), and NPV (99%).
Conclusions:
- Chest ultrasound is a rapid, non-ionizing, and feasible imaging technique for pediatric pneumonia.
- Its high negative predictive value suggests ultrasound can replace X-rays for excluding lung consolidation.
- Utilizing ultrasound can significantly decrease radiation exposure in the pediatric population.
Objective:
The objective of this study was to evaluate the performance of ultrasound in detecting lung consolidation in children suspected of pneumonia, in comparison to the current gold standard, chest X-rays.
Materials And Methods:
From September 2013 to June 2014, a monocentric prospective study was performed on all children between 0 and 16 years-old, referred for chest X-ray for suspected pneumonia. Each child was examined by chest ultrasound by an examiner blinded to the chest X-ray. The presence or absence of areas of consolidation, their number and location were noted for each technique. The size of the consolidations identified only on ultrasound was compared with that of consolidations visible on both techniques.
Results:
143 children (mean age 3 years; limits between 8days and 14 years) were included. Ultrasound detected at least one area of consolidation in 44 out of 45 patients with positive X-rays. Of the 59 areas of consolidation on X-ray, ultrasound identified 54. In the 8 patients with negative X-ray, ultrasound revealed 17 areas of consolidation. The mean size of consolidations visible only on ultrasound was 9.4mm; for consolidations visible on both techniques the mean size was 26mm (p<0.0001). The sensitivity and specificity of ultrasound were calculated at 98% and 92%. PPV and NPV were 85% and 99%, respectively.
Conclusion:
Chest ultrasound is a fast, non-ionizing and feasible technique. With its high negative predictive value, it can replace X-rays in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.
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