copyright restrictions may apply prospective evaluation of point-of-care ultrasonography for the...
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Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of
Pneumonia in Children and Young Adults
Shah VP, Tunik MG, Tsung JW. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. Published online December 10, 2012. doi:10.1001/2013.jamapediatrics.107.
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• Background– Pneumonia is the leading cause of death in children worldwide.
– There is poor access to diagnostic imaging worldwide.
– Ultrasonography for evaluating pneumonia is feasible and accurate in adults
• Study Objective– To determine the accuracy of clinician-performed point-of-care
ultrasonography for the diagnosis of pneumonia in children and young adults.
Introduction
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• Study Design– Prospective observational study with a convenience sample of patients.
• Setting– Patients presenting to an urban pediatric emergency department who
underwent chest radiography for clinical suspicion of pneumonia had lung ultrasonography performed.
• Patients– Aged 0-21 years and seen in the emergency department with a clinical
suspicion of pneumonia.– Excluded patients who had a previous diagnosis of pneumonia, arrived
with a chest radiograph, and had hemodynamic instability.
Methods
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Methods
• Intervention
– Enrolled patients had routine examination done with auscultation findings documented and then had lung ultrasonography performed.
• Outcomes/Analyses– Clinical follow-up in 2 weeks to determine (1) clinical improvement or
deterioration with or without antibiotics and (2) need for unscheduled or repeated emergency department visit.
• Limitations – The use of chest radiography as the reference gold standard.– The presence of centrally located pneumonias that did not reach the
pleural line and therefore were undetected by ultrasonography.
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ResultsTest Performance Characteristics Using Chest Radiography
as a Reference Standard Among 200 Patients
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ResultsStandards for Reporting of Diagnostic Accuracy flowchart.
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Results
aLung consolidations with sonographic air bronchograms were found measuring between 1.5 and 1.8 cm at the detection limit of chest radiography. bOne of 13 patients had lung consolidation of ≤1 cm without sonographic air bronchograms, indicating consolidation from atelectasis as opposed to pneumonia. Twelve of 13 patients had lung consolidation of ≤1 cm with sonographic air bronchograms, consistent with pneumonia.
In addition, Cohen κ was 0.93 (95% CI, 0.87-0.99) between enrolling sonologist interpretation of lung consolidation and expert sonologist review.
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Comment
• Ultrasonography is:
– More specific than sensitive for the detection of pneumonia.
– More accurate than World Health Organization–defined tachypnea and auscultation for the diagnosis.
• Clinician sonologists were able to accurately and quickly (mean time, 7 minutes) diagnose pneumonia in children.
• There was no statistically significant difference in accuracy between sonologists who performed more than 25 lung ultrasonographic examinations and novice sonologists.
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Comment
• Ultrasonography can detect <1-cm lung consolidations missed by chest radiography.
• Point-of-care ultrasonography can be a powerful diagnostic tool to complement the physical examination.
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• If you have questions, please contact the corresponding author:
– James W. Tsung, MD, MPH, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029 ([email protected]).
Conflict of Interest Disclosures
• None reported.
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