scholarly journals Is lung ultrasonography a useful method to diagnose children with community-acquired pneumonia in emergency settings?

2018 ◽  
Vol 26 (2) ◽  
pp. 91-97 ◽  
Author(s):  
Aykut Çağlar ◽  
Emel Ulusoy ◽  
Anıl Er ◽  
Fatma Akgül ◽  
Hale Çitlenbik ◽  
...  
Keyword(s):  
Gold Standard ◽  
Radiation Risk ◽  
Pediatric Emergency ◽  
Clinical Findings ◽  
Community Acquired Pneumonia ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
Lung Ultrasonography ◽  
X Ray ◽  
Chest X Ray

Background: Lung ultrasonography is a new method for diagnosing community-acquired pneumonia. Lung ultrasonography has some advantages over chest X-ray, such as lack of ionizing radiation risk, bedside performance, and cost-effectiveness. Objectives: In this study, we aimed to determine the feasibility of lung ultrasonography in emergency settings in children with community-acquired pneumonia. Methods: The study included patients younger than 18 years of age with suspicion of community-acquired pneumonia. On the first evaluation, patients with positive clinical and/or chest X-ray findings were defined to have community-acquired pneumonia, and this was accepted as the gold standard. The chest X-rays were evaluated by the chief of the pediatric emergency department, who was blinded to the patients and the lung ultrasonography results. Lung ultrasonography was performed by another pediatric emergency physician who was also blinded to the chest X-ray results and clinical findings such as fever, respiratory distress, rales, and wheezing. Results: Of the 91 patients enrolled, 71 (78.0%) were diagnosed with community-acquired pneumonia based on clinical and chest X-ray findings. The median (interquartile range) duration of the lung ultrasonography procedure was 4.0 (3.5–6.0) min. Shred sign, air bronchogram, and hepatization were significantly more frequent in the patients with community-acquired pneumonia ( p < 0.01, p < 0.01, and p = 0.01, respectively). Sensitivity and specificity of lung ultrasonography were 78.5% (67.1–87.4) and 95.2% (76.1–99.8), respectively. Conclusion: Lung ultrasonography is a useful diagnostic method for children with suspicion of community-acquired pneumonia.

Retrospective Review of Clinical and Chest X-Ray Findings in Children Admitted to a Community Hospital for Respiratory Syncytial Virus Infection

2018 ◽  
Vol 57 (14) ◽  
pp. 1686-1692 ◽  
Author(s):  
Denver Niles ◽  
Brett Larsen ◽  
Arvind Balaji ◽  
Dana Delaney ◽  
Elizabeth Campos ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Pediatric Intensive Care ◽  
Clinical Findings ◽  
X Rays ◽  
Radiological Findings ◽  
X Ray ◽  
Severe Group ◽  
Rsv Infection ◽  
Chest X Ray ◽  
Syncytial Virus

Introduction. We performed a retrospective study to evaluate demographics, clinical course, outcome, and radiological findings of children with respiratory syncytial virus (RSV) infection. Methods. Four hundred patients admitted between October 2013 and May 2016 were enrolled. Clinical and radiographic trends were evaluated for association with severity of RSV presentation. Severity was defined as hospitalization >2 days, pediatric intensive care unit admission, or need for mechanical ventilation. Results. Common clinical findings included fever (78.5%), coughing (97%), rhinorrhea/congestion (93%), and hypoxia (44.8%). Hypoxia was seen in 64.7% of the severe group compared with 32.0% in the nonsevere group ( P < .001). Airspace opacification was seen in 49.2% of chest X-rays of the severe group compared with 26.4% in the nonsevere group ( P < .001). Conclusion. Higher incidence of hypoxia or airspace opacification on chest X-ray may be predictors of poorer outcomes for patients with RSV infection.

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments

2019 ◽  
Vol 58 (9) ◽  
pp. 1008-1018 ◽  
Author(s):  
Andrea V. Rivera-Sepulveda ◽  
Terri Rebmann ◽  
James Gerard ◽  
Rachel L. Charney
Keyword(s):  
Online Survey ◽  
Pediatric Emergency ◽  
Systemic Steroid ◽  
X Rays ◽  
Chi Square ◽  
X Ray ◽  
American Academy Of Pediatrics ◽  
Physician Compliance ◽  
Chest X Ray ◽  
Viral Testing

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

scholarly journals P016: Low risk ankle rule, high reward-a quality improvement initiative to reduce ankle x-rays in the pediatric emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83 ◽  
Author(s):  
F. Al-Sani ◽  
M. Ben-Yakov ◽  
G. Harvey ◽  
J. Gantz ◽  
D. Jacobson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Tertiary Care ◽  
Pediatric Emergency ◽  
Ankle Injuries ◽  
Pediatric Emergency Department ◽  
X Rays ◽  
X Ray ◽  
Return Visits ◽  
Unnecessary Testing

Introduction: Our tertiary care institution embarked on the Choosing Wisely campaign to reduce unnecessary testing, and selected the reduction of ankle x-rays as part of its top five priority initiatives. The Low Risk Ankle Rule (LRAR), an evidence-based decision rule, has been derived and validated to clinically evaluate ankle injuries which do not require radiography. The LRAR, is cost-effective, has 100% sensitivity for clinically important ankle injuries and reduces ankle imaging rates by 30-60% in both academic and community setting. Our objective was to significantly reduce the proportion of ankle x-rays ordered for acute ankle injuries presenting to our pediatric Emergency Department (ED). Methods: Medical records were reviewed for all patients presenting to our tertiary care pediatric ED (ages 3- 18 years) with an isolated acute ankle injury from Jan 1, 2016-Sept 30, 2016. Children with outside imaging, an injury that occurred &gt;72 hours prior, or those who had a repeat ED visit for same injury were excluded. Quality improvement (QI) initiatives included multidisciplinary staff education about the LRAR, posters placed within the ED highlighting the LRAR, development of a new diagnostic imaging requisition for ankle x-rays requiring use of the LRAR and collaboration with the Division of Radiology to ensure compliance with new requisition. The proportion of patients presenting to the ED with acute ankle injuries who received x-rays was measured. ED length of stay (LOS), return visits to the ED and orthopedic referrals were collected as balancing measures. Results: At baseline 88% of patients with acute ankle injuries received x-rays. Following our multiple interventions, the proportion of x-rays decreased significantly to 54%, (p&lt;0.001). This decrease in x-ray rate was not associated with an increase in ED LOS, ED return visits or orthopedic referrals. There was an increase uptake of the dedicated x-ray requisition over time to 71%. Conclusion: This QI initiative to increase uptake of the LRAR, resulted in a significant reduction of ankle x-rays rates for children presenting with acute ankle injuries in our pediatric ED without increasing LOS, return visits or need for orthopedic referrals for missed injuries. Just as in the derivation and validation studies, the reductions have been sustained and reduced unnecessary testing and ionizing radiation.

scholarly journals Deep Learning for Screening COVID-19 using Chest X-Ray Images

2020 ◽  
Author(s):  
Sanhita Basu ◽  
Sushmita Mitra ◽  
Nilanjan Saha
Keyword(s):  
Deep Learning ◽  
Lung Parenchyma ◽  
Clinical Findings ◽  
Data Sets ◽  
X Rays ◽  
X Ray ◽  
Chest X Ray ◽  
Increasing Demand ◽  
Novel Coronavirus ◽  
Diverse Data

AbstractWith the ever increasing demand for screening millions of prospective “novel coronavirus” or COVID-19 cases, and due to the emergence of high false negatives in the commonly used PCR tests, the necessity for probing an alternative simple screening mechanism of COVID-19 using radiological images (like chest X-Rays) assumes importance. In this scenario, machine learning (ML) and deep learning (DL) offer fast, automated, effective strategies to detect abnormalities and extract key features of the altered lung parenchyma, which may be related to specific signatures of the COVID-19 virus. However, the available COVID-19 datasets are inadequate to train deep neural networks. Therefore, we propose a new concept called domain extension transfer learning (DETL). We employ DETL, with pre-trained deep convolutional neural network, on a related large chest X-Ray dataset that is tuned for classifying between four classes viz. normal, other_disease, pneumonia and Covid — 19. A 5-fold cross validation is performed to estimate the feasibility of using chest X-Rays to diagnose COVID-19. The initial results show promise, with the possibility of replication on bigger and more diverse data sets. The overall accuracy was measured as 95.3% ± 0.02. In order to get an idea about the COVID-19 detection transparency, we employed the concept of Gradient Class Activation Map (Grad-CAM) for detecting the regions where the model paid more attention during the classification. This was found to strongly correlate with clinical findings, as validated by experts.

scholarly journals Quantitative Analysis of Lung Ultrasonography for the Detection of Community-Acquired Pneumonia: A Pilot Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Francesco Corradi ◽  
Claudia Brusasco ◽  
Alessandro Garlaschi ◽  
Francesco Paparo ◽  
Lorenzo Ball ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Quantitative Analysis ◽  
Community Acquired Pneumonia ◽  
Lung Ultrasonography ◽  
X Ray ◽  
Thoracic Computed Tomography ◽  
Chest X Ray ◽  
Spontaneously Breathing ◽  
Suspected Pneumonia ◽  
Higher Sensitivity

Background and Objective. Chest X-ray is recommended for routine use in patients with suspected pneumonia, but its use in emergency settings is limited. In this study, the diagnostic performance of a new method for quantitative analysis of lung ultrasonography was compared with bedside chest X-ray and visual lung ultrasonography for detection of community-acquired pneumonia, using thoracic computed tomography as a gold standard.Methods. Thirty-two spontaneously breathing patients with suspected community-acquired pneumonia, undergoing computed tomography examination, were consecutively enrolled. Each hemithorax was evaluated for the presence or absence of abnormalities by chest X-ray and quantitative or visual ultrasonography.Results. Quantitative ultrasonography showed higher sensitivity (93%), specificity (95%), and diagnostic accuracy (94%) than chest X-ray (64%, 80%, and 69%, resp.), visual ultrasonography (68%, 95%, and 77%, resp.), or their combination (77%, 75%, and 77%, resp.).Conclusions. Quantitative lung ultrasonography was considerably more accurate than either chest X-ray or visual ultrasonography in the diagnosis of community-acquired pneumonia and it may represent a useful first-line approach for confirmation of clinical diagnosis in emergency settings.

scholarly journals PROFILE OF COMMUNITY ACQUIRED PNEUMONIA IN CHILDREN AT SOETOMO HOSPITAL SURABAYA IN 00–00

2015 ◽  
Vol 2 (1) ◽  
pp. 12
Author(s):  
Retno Asih Setyoningrum
Keyword(s):  
Primary Diagnosis ◽  
Clinical Findings ◽  
Study Data ◽  
Community Acquired Pneumonia ◽  
Clinical Syndrome ◽  
Radiological Examination ◽  
Common Symptom ◽  
X Ray ◽  
Important Health ◽  
Chest X Ray

Background: Community Acquired Pneumonia (CAP) is one of the most important health problem affecting children all over the world. Clinical findings, laboratory and radiological examination of CAP may largely vary from mild to severe. Objective: To report profile of CAP in children hospitalized at Soetomo Hospital Surabaya in 2007–2008 Methods: This research was a retrospective study. Data of children with primary diagnosis of CAP in 2007–2008 were obtained from medical records of the Department of Child Health Soetomo Hospital Surabaya. The diagnosis CAP was based on WHO criteria (pneumonia clinical syndrome). The clinical features of illness, laboratory and radiological examination were recorded and presented descriptively. Results: During the study period, 438 patients were diagnosed as CAP. More than half (83.4%) patients aged 3 months– 3 year. Beside cough and tachypnea, most common symptom and signs were chest indrawing (76.2%) and fever (23.8%). Leucocytosis (39.6%). Bacteria was found in 8.2%. Accompanying diseases (i.e congenital heart disease, neurological and gastroenterological disorders) were found in 36.4%. One hundred fifty seven patients (35.8%) had malnutrition. Patchy infiltrate was found in 80.8% chest X-ray examination. Mortality was found in 4.3%. Conclusions: Community acquired pneumonia in children still count as a major problem at Soetomo Hospital Surabaya.

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