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Updated: Sep 25, 2025
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Pediatric Lung Ultrasound (PLUS) in the diagnosis of Community-Acquired Pneumonia (CAP) requiring hospitalization
Neetu Talwar1, Lucky Manik1, Krishan Chugh1
1Division of Pediatric Pulmonology, Fortis Memorial Research Institute, Gurugram, Haryana, India.
Insights
Pediatric lung ultrasound (PLUS) is a highly accurate diagnostic tool for childhood pneumonia, showing greater sensitivity and specificity than chest X-ray (CXR). This study supports PLUS as a preferred initial investigation for hospitalized children with community-acquired pneumonia (CAP).
Area of Science:
- Pediatric imaging
- Diagnostic accuracy studies
- Pulmonology
Background:
- Community-acquired pneumonia (CAP) is a common pediatric illness.
- Chest X-ray (CXR) is the standard imaging modality, but pediatric lung ultrasound (PLUS) offers a promising alternative.
- Limited data exists on PLUS utility in India.
Purpose of the Study:
- To compare the diagnostic accuracy of PLUS versus CXR in hospitalized children diagnosed with CAP.
- To evaluate PLUS as a potential primary diagnostic tool in this population.
Main Methods:
- Prospective observational study conducted from June 2017 to September 2019.
- Included hospitalized children aged 3 months to 18 years with CAP, excluding specific comorbidities.
- Performed PLUS and CXR within 6 hours of each other and 24 hours of admission.
Main Results:
- PLUS demonstrated higher sensitivity (95.27%) and specificity (92.90%) compared to CXR (86.49% sensitivity, 90.27% specificity).
- Abnormalities were detected by PLUS in 95.27% of patients and by CXR in 86.48%.
- PLUS identified pneumonia in all cases where CXR was normal (90% of 20 cases).
Conclusions:
- Pediatric lung ultrasound (PLUS) is a sensitive and specific diagnostic tool for CAP in hospitalized children.
- PLUS can be considered the preferred initial imaging investigation over CXR for pediatric CAP.
- This finding is particularly relevant given the limited existing literature in the Indian context.
Background:
In childhood pneumonia, pediatric lung ultrasound (PLUS) is a very sensitive and specific diagnostic alternative to chest X-ray (CXR). However, there is a paucity of literature on this in India. We set out to compare the diagnostic accuracy of PLUS and CXR in hospitalized children with community-acquired pneumonia (CAP).
Setting And Design:
Prospective, observational study (June 2017-September 2019) at a tertiary care hospital.
Methods:
Hospitalized children of CAP (3 months-18 years) were included after taking informed, written consent. Hemodynamic instability, asthma, cystic fibrosis, congenital heart disease, immunodeficiency, and malignancy cases were excluded. CXR (frontal view) and PLUS were done within 6 h of each other and within 24 h of hospitalization. Statistical analysis was performed using SPSS software version 25.
Results:
Out of 612 consecutive, hospitalized respiratory cases, 261 were recruited. CAP was diagnosed clinically in 148 (56.7%) patients [95 boys (64.19%), mean age in years ± SD: 4.31 ± 4.41]. Abnormal PLUS was present in 141 (95.27%) and abnormal CXR in 128 (86.48%) patients. In radiologically diagnosed pneumonia, PLUS was detected in 123 [123/128 (96.09%)] children, and when CXR was normal, PLUS was abnormal in 18 [18/20 (90%)]. PLUS showed a sensitivity of 95.27% (95%CI: 90.50-98.08) and a specificity of 92.90% (95%CI: 86.53-96.89). CXR showed a sensitivity of 86.49% (95%CI: 79.9-91.55) and a specificity of 90.27% (95%CI: 83.25-95.04).
Conclusions:
PLUS is a sensitive, specific test and can be considered as the preferred investigation before CXR in children hospitalized with CAP.
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