Diagnostic accuracy of lung ultrasonography in childhood pneumonia

Background Lung auscultation and bedside chest radiography are routinely used to assess the respiratory condition of ventilated patients with acute respiratory distress syndrome (ARDS). Clinical experience suggests that the diagnostic accuracy of these procedures is poor. Methods This prospective study of 32 patients with ARDS and 10 healthy volunteers was performed to compare the diagnostic accuracy of auscultation, bedside chest radiography, and lung ultrasonography with that of thoracic computed tomography. Three pathologic entities were evaluated in 384 lung regions (12 per patient): pleural effusion, alveolar consolidation, and alveolar-interstitial syndrome. Results Auscultation had a diagnostic accuracy of 61% for pleural effusion, 36% for alveolar consolidation, and 55% for alveolar-interstitial syndrome. Bedside chest radiography had a diagnostic accuracy of 47% for pleural effusion, 75% for alveolar consolidation, and 72% for alveolar-interstitial syndrome. Lung ultrasonography had a diagnostic accuracy of 93% for pleural effusion, 97% for alveolar consolidation, and 95% for alveolar-interstitial syndrome. Lung ultrasonography, in contrast to auscultation and chest radiography, could quantify the extent of lung injury. Interobserver agreement for the ultrasound findings as assessed by the kappa statistic was satisfactory: 0.74, 0.77, and 0.73 for detection of alveolar-interstitial syndrome, alveolar consolidation, and pleural effusion, respectively. Conclusions At the bedside, lung ultrasonography is highly sensitive, specific, and reproducible for diagnosing the main lung pathologic entities in patients with ARDS and can be considered an attractive alternative to bedside chest radiography and thoracic computed tomography.

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Lung Ultrasonography May Not Be a Reliable Alternative to Chest Radiography in Childhood Pneumonia

CHEST Journal ◽

10.1016/j.chest.2016.10.059 ◽

2017 ◽

Vol 151 (1) ◽

pp. 244 ◽

Cited By ~ 2

Author(s):

Paolo Toma

Keyword(s):

Chest Radiography ◽

Lung Ultrasonography ◽

Childhood Pneumonia

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Utility and diagnostic accuracy of bedside lung ultrasonography during medical emergency team (MET) activations for respiratory deterioration

Journal of Critical Care ◽

10.1016/j.jcrc.2017.03.007 ◽

2017 ◽

Vol 40 ◽

pp. 58-62

Author(s):

Soumitra Sen ◽

Ghazwan Acash ◽

Akmal Sarwar ◽

Yuxiu Lei ◽

James M. Dargin

Keyword(s):

Diagnostic Accuracy ◽

Medical Emergency Team ◽

Medical Emergency ◽

Lung Ultrasonography ◽

Emergency Team

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Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure

JAMA Network Open ◽

10.1001/jamanetworkopen.2019.0703 ◽

2019 ◽

Vol 2 (3) ◽

pp. e190703 ◽

Cited By ~ 42

Author(s):

Anna M. Maw ◽

Ahmed Hassanin ◽

P. Michael Ho ◽

Matthew D. F. McInnes ◽

Angela Moss ◽

...

Keyword(s):

Heart Failure ◽

Diagnostic Accuracy ◽

Chest Radiography ◽

Acute Decompensated Heart Failure ◽

Point Of Care ◽

Decompensated Heart Failure ◽

Lung Ultrasonography

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Neonatal lung ultrasonography to evaluate need for surfactant or mechanical ventilation: a systematic review and meta-analysis

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2019-316832 ◽

2019 ◽

Vol 105 (2) ◽

pp. 164-171 ◽

Cited By ~ 8

Author(s):

Abdul Razak ◽

Maher Faden

Keyword(s):

Mechanical Ventilation ◽

Diagnostic Accuracy ◽

Respiratory Distress ◽

Preterm Infants ◽

Late Preterm ◽

Lung Ultrasonography ◽

Term Infants ◽

Surfactant Treatment ◽

Increased Risk

ContextLung ultrasonography (LUS) is increasingly used to identify various neonatal respiratory disorders. There is emerging evidence that it can identify infants with significant lung disease who need surfactant treatment or mechanical ventilation.ObjectiveTo systematically review the accuracy of LUS in determining the need for surfactant treatment or mechanical ventilation in infants with respiratory distress treated with nasal continuous positive airway pressure (NCPAP).MethodsDatabase search include EMBASE, Medline, CINAHL and Cochrane central from inception until 17 October 2018. Included is diagnostic accuracy studies reporting LUS evaluating surfactant therapy/mechanical ventilation. Two authors extracted data independently and assessed quality. Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to determine the methodological quality.ResultsSix studies involving 485 infants included in the review. Three studies used LUS score, two used type 1 lung profile, and one used high-risk LUS to evaluate the outcome. The pooled sensitivity and specificity at LUS score cut-off >5–6 was 88% (95% CI 80% to 93%) and 82% (95% CI 74% to 89%), respectively. Infants with LUS score >5–6 were at significantly increased risk of surfactant treatment compared with infants with LUS score <5–6 (relative risk=7.51; 95% CI 4.16 to 13.58; two studies; participants=189; I2=0%). The diagnostic accuracy of type 1 lung profile was better in younger preterm infants (sensitivity 88.9%, specificity 100%) compared with late preterm and term infants (sensitivity 100%, specificity 28%).ConclusionsLUS, particularly LUS score, can be used accurately to determine the need for surfactant replacement treatment or mechanical ventilation in infants with respiratory distress treated with NCPAP support. The accuracy is better in younger preterm infants compared with late preterm and term infants.PROSPERO registration numberCRD42018115135.

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Comparison of Lung Ultrasound to X-ray for Diagnosis of Pulmonary Complications after Cardiac Surgery in Children

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i1.2236 ◽

2020 ◽

Vol 18 (1) ◽

pp. 47-51

Author(s):

Smriti Mahaju Bajracharya ◽

Pragati Shrestha ◽

Apurb Sharma

Keyword(s):

Cardiac Surgery ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Lung Ultrasound ◽

Pulmonary Complications ◽

Lung Ultrasonography ◽

X Ray ◽

Chest X Ray

Background: The purpose of this study was to compare diagnostic performance of lung ultrasound in comparison to chest X-ray to detect pulmonary complication after cardiac surgery in children.Methods: A prospective observational study was conducted in tertiary center of Nepal. 141 consecutive paediatric patients aged less than 14 years scheduled for cardiac surgery were enrolled during the 6 months period. Ultrasound was done on the first post-operative day of cardiac surgery and compared to chest X-ray done on the same day to detect pleural effusion, consolidation, atelectasis and pneumothorax.Results: Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated using standard formulas. lung ultrasonography had overall sensitivity of 60 %, specificity of 72.4%, positive predictive value of 31.9% and negative predictive value of 89.3% and diagnostic accuracy of 70.2% for diagnosing consolidation. Similarly, lung ultrasonography had overall sensitivity of 90%, specificity of 82.6%, positive predictive value of 46.1% and negative predictive value of 98% and diagnostic accuracy of 83.6 % for diagnosing pleural effusion. For atelectasis, ultrasonography had sensitivity of 50%, specificity of 76.9%, positive predictive value of 30.7% and negative predictive value of 88.2% and diagnostic accuracy of 72.3%. No pneumothoraxes were detected during our study period. Conclusions: Lung ultrasound is an alternative non-invasive technique which is able to diagnose pulmonary complications after cardiac surgery with acceptable diagnostic accuracy with no proven complications but with decreasing exposure to ionizing radiation and possibly cost.Keywords: Cardiac surgery; children; lung ultrasound; pulmonary complications

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Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-036067 ◽

2020 ◽

Vol 10 (6) ◽

pp. e036067

Author(s):

Julie Jepsen Strøm ◽

Pia Sperling Haugen ◽

Malene Plejdrup Hansen ◽

Ole Graumann ◽

Martin Bach B Jensen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Community Acquired Pneumonia ◽

Significant Heterogeneity ◽

Cochrane Central Register ◽

Lung Ultrasonography ◽

Ultrasound Education ◽

Central Register ◽

Registration Number ◽

Criteria For Diagnosis

ObjectivesWe aimed to systematically review the published literature regarding adults with clinical suspicion of pneumonia that compares the accuracy of lung ultrasonography (LUS) performed by non-imaging specialists to other reference standards in diagnosing and evaluating the severity of community-acquired pneumonia. Moreover, we aimed to describe LUS training and the speciality of the physician performing LUS, time spent on the LUS procedure and potential harms to patients.Materials and methodsWe searched MEDLINE, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials up until May 2019. We included studies that used LUS to diagnose pneumonia, but also confirmed pneumonia by other means. Publications were excluded if LUS was performed by a sonographer or radiologist (imaging specialists) or performed on other indications than suspicion of pneumonia. Two review authors screened and selected articles, extracted data and assessed quality using Quality Assessment of Diagnostic Accuracy Studies 2.ResultsWe included 17 studies. The sensitivity of LUS to diagnose pneumonia ranged from 0.68 to 1.00; however, in 14 studies, sensitivity was ≥0.91. Specificities varied from 0.57 to 1.00. We found no obvious differences between studies with low and high diagnostic accuracy. The non-imaging specialists were emergency physicians, internal medicine physicians, intensivists or ‘speciality not described’. Five studies described LUS training, which varied from a 1-hour course to fully credentialed ultrasound education. In general, the methodological quality of studies was good, though, some studies had a high risk of bias.ConclusionWe found significant heterogeneity across studies. In the majority of studies, LUS in the hands of the non-imaging specialists demonstrated high sensitivities and specificities in diagnosing pneumonia. However, due to problems with methodology and heterogeneity there is a need for larger studies with uniform and clearly established criteria for diagnosis and blinding.PROSPERO registration numberProspectively registered in PROSPERO (CRD42017057804).

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