Diagnostic Accuracy of Lung Ultrasound for Detecting Pneumonia in Children: A Comparative Study with Chest Radiography
Keywords:
Lung Ultrasound, Pediatric Pneumonia, Diagnostic AccuracyAbstract
Background: Pneumonia still tops the list of diseases that cause high rates of illness and death in children all over the world, especially in countries with low and moderate incomes. Accurate and early diagnosis plays a major role in prompt treatment; however, the chest X-ray technique that provides such diagnosis cannot be used due to radiation exposure, inaccessibility, and the long wait for reports. Lung ultrasound (LUS) has emerged as a non-radiation, fast, and at-the-bedside technique that may provide better diagnostic accuracy in pediatric pneumonia. Objective: To evaluate the diagnostic accuracy of lung ultrasound (LUS) in identifying pneumonia among pediatric patients and to compare its performance with standard chest radiography. Methodology: This cross-sectional diagnostic accuracy study was conducted at the Departments of Pediatrics and Radiology at Nishtar Medical University in Multan from January 2022 to March 2023. Enlistment included a group of 320 children with a clinical suspicion of pneumonia, who were aged between 6 months and 12 years. Lung ultrasonography was performed on all patients, followed by chest radiography. An experienced radiologist who was unaware of the CXR results interpreted the LUS findings. Diagnostic indices such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated using chest radiography as the gold standard. Results:Among 320 screened children, 120 (37.5%) had radiographically confirmed pneumonia. LUS identified pneumonia in 142 cases. Sensitivity, specificity, PPV, NPV, and overall accuracy of LUS were 95.8%, 86.0%, 80.9%, 96.9%, and 89.7%, respectively. LUS showed high performance across all age groups. Conclusion:Lung ultrasound demonstrated excellent sensitivity and strong diagnostic accuracy for pediatric pneumonia, indicating its potential as a reliable, radiation-free alternative to chest radiography in routine clinical practice.References
Cohen AL, Platts-Mills JA, Nakamura T, Operario DJ, Antoni S, Mwenda JM, et al. Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network. BMJ Glob Health. 2022;7(9):e009548. DOI:10.1136/bmjgh-2022-009548.
Kevat PM, Morpeth M, Graham H, Gray AZ. A systematic review of the clinical features of pneumonia in children aged 5-9 years: Implications for guidelines and research. Journal Glob Health. 2022;12:10002. DOI:10.7189/jogh.12.10002.
Chen Y, Roberts CS, Ou W, Petigara T, Goldmacher GV, Fancourt N, Knoll MD. Deep learning for classification of pediatric chest radiographs by WHO’s standardized methodology. PLoS One. 2021;16(6):e0253239. DOI:10.1371/journal.pone.0253239.
Urbankowska E, Krenke K, Drobczy?ski ?, Korczy?ski P, Urbankowski T, Krawiec M, et al. Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children. Respir Med. 2015;109(9):1207-12. DOI:10.1016/j.rmed.2015.06.011
Boice Jr JD. Radiation epidemiology and recent paediatric computed tomography studies. Annals ICRP. 2015;44(1_suppl):236-48. DOI:10.1177/0146645315575877.
Lu X, Jin Y, Li Y, Weng L, Li H. Diagnostic accuracy of lung ultrasonography in childhood pneumonia: a meta-analysis. Eur J Emerg Med. 2022;29(2):105-17. DOI:10.1097/MEJ.0000000000000883.
Balk DS, Lee C, Schafer J, Welwarth J, Hardin J, Novack V, Yarza S, Hoffmann B. Lung ultrasound compared to chest X?ray for diagnosis of pediatric pneumonia: a meta?analysis. Pediatr Pulmonol. 2018;53(8):1130-9. DOI:10.1002/ppul.24020
Xin H, Li J, Hu HY. Is lung ultrasound useful for diagnosing pneumonia in children?: A meta-analysis and systematic review. Ultrasound Q. 2018;34(1):3-10. DOI:10.1097/RUQ.0000000000000330.
Najgrodzka P, Buda N, Zamojska A, Marciniewicz E, Lewandowicz-Uszy?ska A. Lung ultrasonography in the diagnosis of pneumonia in children—a metaanalysis and a review of pediatric lung imaging. Ultrasound Q. 2019;35(2):157-63. DOI:10.1097/RUQ.0000000000000411.
Afifa M, Ahmed MN, Ferdous M, Hossain MM. Role of Lung Ultrasound for Diagnosis of Acute Respiratory Distress Syndrome in Intensive Care Unit. Bangl Crit Care J. 2022;10(2):104-9. DOI:10.3329/bccj.v10i2.62202.
Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015;135(4):714–722. DOI:10.1542/peds.2014-2833.
Conlon TW, Nishisaki A, Singh Y, Bhombal S, De Luca D, Kessler DO, Su ER, Chen AE, Fraga MV. Moving beyond the stethoscope: diagnostic point-of-care ultrasound in pediatric practice. Pediatrics. 2019;144(4). DOI:10.1542/peds.2019-1402.
Urbankowska E, Urbankowski T, Drobczy?ski ?, Griese M, Lange J, Brzewski M, et al. Lung ultrasound—a new diagnostic modality in persistent tachypnea of infancy. Pediatr Pulmonol. 2020;55(4):1028-36. DOI:10.1002/ppul.24654.
Yan JH, Yu N, Wang YH, Gao YB, Pan L. Lung ultrasound vs chest radiography in the diagnosis of children pneumonia: systematic evidence. Medicine. 2020;99(50):e23671. DOI:10.1097/MD.0000000000023671.
Sansone F, Attanasi M, Di Filippo P, Sferrazza Papa GF, Di Pillo S, Chiarelli F. Usefulness of lung ultrasound in paediatric respiratory diseases. Diagnostics. 2021;11(10):1783. DOI:10.3390/diagnostics11101783.
Lissaman C, Kanjanauptom P, Ong C, Tessaro M, Long E, O’Brien A. Prospective observational study of point-of-care ultrasound for diagnosing pneumonia. Arch Dis Child. 2019;104(1):12-8.
Raimondi F, Yousef N, Migliaro F, Capasso L, De Luca D. Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res. 2021;90(3):524-31. DOI:10.1038/s41390-018-0114-9.
Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, et al. Ten years of pediatric lung ultrasound: a narrative review. Front Physiol. 2022;12:721951. DOI:10.3389/fphys.2021.721951.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2020 Pakistan Journal of Chest Medicine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
