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Lung ultrasound patterns in paediatric pneumonia in Mozambique and Pakistan
Amy Sarah Ginsburg1, Pio Vitorino2, Zunera Qasim3
1Dept of Biostatistics, University of Washington, Seattle, WA, USA.
Insights
Lung ultrasound (LUS) shows distinct patterns in pediatric pneumonia, differing by location and pathogen. While reliable for expert interpretation, LUS-CXR pattern agreement is poor, necessitating further standardization.
Area of Science:
- Pediatric Pulmonology
- Medical Imaging
- Infectious Diseases
Background:
- Pneumonia diagnosis requires improvement, especially in resource-limited settings.
- Lung ultrasound (LUS) is a promising point-of-care diagnostic tool.
- Understanding LUS patterns in pediatric pneumonia is crucial.
Purpose of the Study:
- To explore distinct lung ultrasound (LUS) patterns associated with pediatric pneumonia.
- To compare LUS findings with chest radiography (CXR) and etiological factors.
Main Methods:
- Prospective observational study in Mozambique and Pakistan.
- Included children aged 2-23 months with and without pneumonia.
- Assessed LUS, CXR, and nasopharyngeal carriage of viruses and bacteria.
Main Results:
- LUS revealed distinctive patterns differentiating pneumonia cases and geographical locations.
- Consolidation and interstitial patterns were more frequent in pneumonia.
- LUS showed high interrater reliability for pneumonia, consolidation, and interstitial patterns (κ > 0.90).
Conclusions:
- LUS patterns associated with pediatric pneumonia vary and show discordance with CXR.
- Further research is needed to standardize LUS patterns for pneumonia diagnosis.
- The potential of LUS as a reference standard requires further evaluation.
Objective:
Improved pneumonia diagnostics are needed, particularly in resource-constrained settings. Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing pneumonia. The objective was to explore LUS patterns associated with paediatric pneumonia.
Methods:
We conducted a prospective, observational study among children aged 2 to 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at two district hospitals in Mozambique and Pakistan. We assessed LUS and chest radiograph (CXR) examinations, and viral and bacterial nasopharyngeal carriage, and performed a secondary analysis of LUS patterns.
Results:
LUS demonstrated a range of distinctive patterns that differed between children with and without pneumonia and between children in Mozambique versus Pakistan. The presence of LUS consolidation or interstitial patterns was more common in children with chest-indrawing pneumonia than in those without pneumonia. Consolidations were also more common among those with only bacterial but no viral carriage detected (50.0%) than among those with both (13.0%) and those with only virus detected (8.3%; p=0.03). LUS showed high interrater reliability among expert LUS interpreters for overall determination of pneumonia (κ=0.915), consolidation (κ=0.915) and interstitial patterns (κ=0.901), but interrater reliability between LUS and CXR for detecting consolidations was poor (κ=0.159, Pakistan) to fair (κ=0.453, Mozambique).
Discussion:
Pattern recognition was discordant between LUS and CXR imaging modalities. Further research is needed to define and standardise LUS patterns associated with paediatric pneumonia and to evaluate the potential value of LUS as a reference standard.