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

Area of Science:

• Pediatric Emergency Medicine
• Pulmonary Medicine
• Medical Ultrasound

Background:

• Pediatric asthma scoring often relies on subjective clinical findings.
• Existing methods for assessing acute wheeze severity in children have poor interrater reliability.

Purpose of the Study:

• To evaluate the utility of ultrasound-derived pleural line excursion in predicting hospital admission for pediatric patients with acute wheeze.
• To develop an objective measure for assessing respiratory distress in children with asthma exacerbations.

Main Methods:

• Prospective study of 50 children presenting to a pediatric emergency department with acute wheeze.
• M-mode ultrasound video was used to measure pleural line excursion via a custom algorithm.
• A multivariate logistic regression model incorporated pleural line excursion, SpO2, heart-rate percentile, and age to predict hospital admission.

Main Results:

• The predictive model achieved an area under the receiver operating characteristic curve (AUC) of 0.81.
• In hypoxic children (SpO2 ≤91.5%), pleural line excursion ≤2.0 mm was associated with a 73% admission rate.
• Conversely, excursion >2.0 mm in hypoxic children correlated with a 17% admission rate.

Conclusions:

• Ultrasound measurement of pleural line excursion shows promise as an objective tool for predicting hospital admission in pediatric wheeze.
• This exploratory study suggests a potential improvement over subjective asthma scoring methods.
• Further prospective validation is required to confirm these findings.