Objectives The clinical diagnosis of pneumonia lacks specificity and may lead to antibiotic overuse, whereas radiological diagnoses can lack sensitivity. Point-of-care lung ultrasound is an emerging diagnostic tool. There are limited prospective data, however, on the accuracy of sonologists in the paediatric emergency department setting. We aimed to test the diagnostic accuracy of lung ultrasound for pneumonia using chest radiograph (CR) as the reference standard.
Methods This prospective observational cohort study in a paediatric emergency department enrolled children aged 1 month to <18 years, who had a CR ordered for possible pneumonia. Lung ultrasounds were performed by two blinded sonologists with focused training. Sonographic pneumonia was defined as lung consolidation with air bronchograms. Radiograph and ultrasound results both required agreement between two readers, with final results determined by an arbiter in cases of disagreement. Patient management was decided by treating clinicians who were blinded to lung ultrasound results. Follow-up was performed by phone and medical record review to obtain final diagnosis and antibiotic use.
Results Of 97 included patients, CR was positive for pneumonia in 44/97 (45%) and lung ultrasound was positive in 57/97 (59%). Ultrasound sensitivity was 91% (95% CI 78% to 98%) and specificity was 68% (95% CI 54% to 80%). Ultrasound results displayed greater consistency with CR and patient outcomes when sonographic consolidation exceeded 1 cm. Thirteen of 57 patients with sonographic consolidation improved without antibiotics.
Conclusion Lung ultrasound may have a role as first-line imaging in patients with possible pneumonia, with higher specificity for consolidations exceeding 1 cm.
Trial registration number ACTRN12616000361404, http://www.ANZCTR.org.au/ACTRN12616000361404.aspx
- paediatric emergency medicine
- point-of-care testing
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Contributors CL: conceptualised and designed the study, enrolled patients, acquired, analysed and interpreted data, drafted the initial manuscript. PK: designed the study, enrolled patients, acquired, analysed and interpreted data. CO and EL: designed the study, analysed and interpreted data. MT: analysed and interpreted data. AOB: conceptualised and designed the study, provided teaching and technical support, analysed and interpreted data, supervised the overall study conduct and analysis. All authors critically revised and approved the final manuscript as submitted.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Informed parental consent. Children over 12 years of age had the option of providing additional informed consent.
Ethics approval This study was conducted with the approval of the Human Resources and Ethics Committee, The Royal Children’s Hospital, Melbourne.
Provenance and peer review Not commissioned; externally peer reviewed.