Sonographic pleural line excursion in children with bronchospasm: a prospective single-center study

Pediatric asthma scoring relies on subjective findings with poor interrater reliability. We prospectively studied children presenting to a pediatric emergency department with acute wheeze requiring beta-agonist therapy, measuring pleural line excursion (maximum minus minimum vertical displacement of the pleural line) from M-mode ultrasound video using a custom algorithm. Fifty children were analyzed. A multivariate logistic regression model constructed to predict hospital admission, combining excursion with peripheral capillary oxygen saturation (SpO₂), age-adjusted heart-rate percentile and age, achieved an area under the receiver operating characteristic curve (AUC) of 0.81. Among hypoxic children (SpO₂ ≤91.5%), excursion ≤2.0 mm conferred a 73% admission rate versus 17% for excursion >2.0 mm. These exploratory findings require prospective validation.