Diagnostic Accuracy of Bedside Lung Ultrasound Versus Chest X-ray for Pediatric Pneumonia in Children Under Five: A...

Pneumonia remains a major cause of under-five mortality, particularly in low-resource settings where early diagnosis is crucial. While chest X-ray (CXR) is the conventional imaging modality, it is limited by radiation exposure and accessibility. Bedside lung ultrasound (LUS) has emerged as a promising, radiation-free alternative, offering real-time pulmonary assessment.

To evaluate the diagnostic accuracy of bedside LUS compared to CXR in children under five presenting with clinical signs of pneumonia, and to analyze the sonographic features associated with pneumonia.

A prospective observational study was conducted on 161 children aged one month to five years with clinical suspicion of pneumonia at a tertiary care hospital over 18 months. LUS was performed at the bedside using a standardized 10-zone protocol. Chest radiographs were interpreted by radiologists blinded to LUS findings. Statistical analysis included sensitivity, specificity, predictive values, and logistic regression for significant predictors.

LUS showed significantly higher sensitivity (86.2%, n=139/161, p=0.0001) and specificity (94.4%, n=85/90, p=0.0001) than CXR (75.6%, n=122/161, and 85.4%, n=77/90, respectively). Key sonographic markers such as shred sign and air bronchograms demonstrated strong diagnostic value. Subpleural consolidations and pleural effusions were better detected with LUS. Shred sign (odds ratio (OR)=8.45) and CRP >20 mg/L (OR=3.50) emerged as strong independent predictors of pneumonia.

Bedside LUS is a reliable and accurate diagnostic modality for pediatric pneumonia. It is especially valuable in early detection and in resource-limited settings, supporting its broader clinical integration.