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Lovrenski J. Pediatric lung ultrasound cons - are they really strong enough? Pediatr Radiol 2020; 50:321-322. [PMID: 32065268 DOI: 10.1007/s00247-019-04554-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/12/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jovan Lovrenski
- Faculty of Medicine, Radiology Department, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, Hajduk Veljkova 10, Novi Sad, 21000, Serbia.
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Abstract
The use of point-of-care ultrasound (POCUS) performed by non-radiologists has become more widespread and is entering new arenas of clinical care. Children in particular are prime candidates for ultrasound, as they are both usually thinner than adults and are particularly at risk from the harmful effects of ionizing radiation. In this two-part article, we propose 10 uses of POCUS that pediatricians can apply to their practice in both inpatient and outpatient settings. [Pediatr Ann. 2020;49(3):e147-e152.].
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Lovrenski J. Pediatric lung ultrasound - pros and potentials. Pediatr Radiol 2020; 50:306-313. [PMID: 32065266 DOI: 10.1007/s00247-019-04525-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
Abstract
Lung ultrasound (US) cannot be considered a new diagnostic imaging technique anymore, with some articles dating back 50 years. The question that hovers over it recently is why it is still not widely accepted, like chest radiography. So, have we wasted a lot of time without using lung US, or are we wasting our time using lung US? The main goals of this article are to underline all the advantages, potentials and reasons to use lung US in everyday clinical practice, but also to address the main concerns linked to this imaging tool. From the standpoint of an experienced pediatric radiologist from a tertiary health care children's hospital who has been performing this examination for more than 10 years on a daily basis, this article also addresses the most common applications of lung US, such as detection of pneumonia and neonatal lung diseases.
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Affiliation(s)
- Jovan Lovrenski
- Radiology Department, Faculty of Medicine, University of Novi Sad and Institute for Children and Adolescents Health Care of Vojvodina, Hajduk Veljkova 3, Novi Sad, 21000, Serbia.
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Tomà P. Lung ultrasound in pediatric radiology - cons. Pediatr Radiol 2020; 50:314-320. [PMID: 32065267 DOI: 10.1007/s00247-019-04524-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/25/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023]
Abstract
In the 1990s, intensivists suggested a new type of sonography: lung ultrasound, based on artefacts that receive information even from physical acoustic phenomena not directly convertible into images of the human body. They compared the artefacts from the lung zones with no acoustic window with various computed tomography (CT) patterns. They used and still use US as a tool to evaluate patients bedside, i.e. monitoring of lung recruitment. They included Lung ultrasound in what was termed POCUS (Point-of-Care Ultrasound). Lung ultrasound has been progressively extended to paediatrics in general. The most appealing novelty has been the diagnosis of pneumothorax. Lung ultrasound was developed as a support tool for critical patients. Extrapolation with mass diffusion, in the absence of appropriate training, has led to misunderstandings and dangerous therapeutic diagnostic drifts.
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Affiliation(s)
- Paolo Tomà
- Ospedale pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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55
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Lung Ultrasonography in the Diagnosis of Pneumonia in Children-A Metaanalysis and a Review of Pediatric Lung Imaging. Ultrasound Q 2020; 35:157-163. [PMID: 30672870 DOI: 10.1097/ruq.0000000000000411] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pneumonia is one of the most frequent widespread and severe infectious diseases in pediatric patients worldwide. Pneumonia is characterized by high incidence and possibility of complications in the course of the disease in pediatric patients. For this reason, there is a need to have a rapid and safe diagnostic method to recognize it. Imaging diagnostic tools, such as x-ray examinations, necessitate caution while using these methods. To date, there have been lots of studies with the aim to determine the role of lung ultrasonography (LUS) in the diagnosis of inflammatory lesions in children. Our aim was to assess the accuracy of the LUS as diagnostic method of pneumonia in children by making a systematic research of literature. OBJECTIVES This work is a review of available literature and studies on LUS in pneumonia in children and summary of necessary information about the usefulness of LUS and sonographic findings to diagnose pneumonia in the pediatric population. METHODS We searched the following databases: PubMed, Scopus, MEDLINE, and Ovid. The following key words were used: pediatrics, pneumonia, ultrasound, chest x-ray, and LUS. RESULTS The total search results amounted to 1987. From 1987 potentially eligible studies, 19 were included, and 3 were meta-analysis. We studied and performed the statistical analysis of the results publication. CONCLUSIONS As a result of the analysis, a significant advantage of the ultrasound examination in comparison with the x-ray study was demonstrated. Lung ultrasound could be a safe diagnostic method for this reason.
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56
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Interrater reliability of pediatric point-of-care lung ultrasound findings. Am J Emerg Med 2020; 38:1-6. [DOI: 10.1016/j.ajem.2019.01.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 01/20/2023] Open
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Gower WA, Birnkrant DJ, Black JB, Noah TL. Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing. Pediatr Pulmonol 2019; 54:1655-1662. [PMID: 31402599 DOI: 10.1002/ppul.24461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 12/31/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports, and review articles on topics related to a wide range of children's respiratory disorders. In this article, we highlight the past year's publications in the topic areas of rare lung diseases, respiratory complications of neuromuscular disorders, and diagnostic testing, as well as selected literature in these areas from other journals.
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Affiliation(s)
- William A Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane B Black
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Pervaiz F, Hossen S, Chavez MA, Miele CH, Moulton LH, McCollum ED, Roy AD, Chowdhury NH, Ahmed S, Begum N, Quaiyum A, Santosham M, Baqui AH, Checkley W. Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia. Pediatr Pulmonol 2019; 54:1753-1759. [PMID: 31432618 PMCID: PMC6899663 DOI: 10.1002/ppul.24477] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/20/2019] [Accepted: 07/09/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of death in children of low-resource settings. Barriers to care include an early and accurate diagnosis. Lung ultrasound is a novel tool for the identification of pediatric pneumonia; however, there is currently no standardized approach to train in image acquisition and interpretation of findings in epidemiological studies. We developed a training program for physicians with limited ultrasound experience on how to use ultrasound for the diagnosis of pediatric pneumonia and how to standardize image interpretation using a panel of readers. METHODS Twenty-five physicians participating in the training program conducted lung ultrasounds in all children with suspected pneumonia, aged 3 to 35 months, presenting to three subdistrict hospitals in Sylhet, Bangladesh, between June 2015 and September 2017. RESULTS A total of 9051 pediatric lung ultrasound assessments were conducted through 27 months of data collection. Study physicians underwent training and all were successfully standardized, achieving 91% agreement and maintained a sensitivity and specificity of 88% and 92%, respectively, when their diagnosis was compared with experts. Overall kappa between two readers was high (0.86, 95% confidence interval [CI], 0.84-0.87), and remained high when a third expert reader was included (0.80, 95% CI, 0.79-0.81). Agreement and kappa statistics were similarly high when stratified by age, sex, presence of danger signs, or hypoxemia. CONCLUSIONS Lung ultrasound is a novel tool for the diagnosis of pediatric pneumonia with evidence supporting its validity and feasibility of implementation. Here we introduced a training program that resulted in a high level of inter-sonographer agreement.
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Affiliation(s)
- Farhan Pervaiz
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Miguel A. Chavez
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Catherine H. Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence H. Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Eric D. McCollum
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
- Eudowood Division of Pediatric Respiratory Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Arun D. Roy
- Johns Hopkins University‐Bangladesh, Dhaka, Bangladesh
| | | | | | - Nazma Begum
- Johns Hopkins University‐Bangladesh, Dhaka, Bangladesh
| | - Abdul Quaiyum
- Reproductive Health Unit, icddr,b, Dhaka, Bangladesh
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Abdullah H. Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Trehan I, Osei‐Ampofo M, Balhara KS, Hexom BJ, Kivlehan SM, Modi P, Pousson AY, Selvam A, Quao NSA, Cho DK, Becker TK, Levine AC, Bannon‐Murphy H, Bartels SA, Beyene T, Bonney J, Collier AT, Cook J, Dyal JW, Enriquez KT, Gomes DJ, Hayward AS, Ibrahim WMA, Keefe DM, Lee JA, Lee S, Lowsby R, Mediratta RP, Mickman CT, Nicholson BD, O'Reilly GM, Relan P, Ragins KT, Reid EA, Roy CM, Rybarczyk MM, Schultz ML, Stanford KA, Vogel LD, Wang AH, Zewdie A. Global Emergency Medicine: A Review of the Literature from 2018. Acad Emerg Med 2019; 26:1186-1196. [PMID: 31313411 DOI: 10.1111/acem.13832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/06/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM. METHODS An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores. RESULTS A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique. CONCLUSIONS In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.
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Affiliation(s)
- Indi Trehan
- Lao Friends Hospital for Children Luang Prabang Lao PDR
- Department of Pediatrics Washington University in St. Louis St. Louis MO
| | - Maxwell Osei‐Ampofo
- Emergency Medicine Directorate Komfo Anokye Teaching Hospital, and the Department of Anaesthesia and Intensive Care Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago IL
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Harvard Humanitarian Initiative Cambridge MA
| | - Payal Modi
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Amelia Y. Pousson
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Anand Selvam
- Department of Emergency Medicine Yale University New Haven CT
| | - Nana Serwaa A. Quao
- Department of Emergency Medicine Korle Bu Teaching Hospital (NSAQ) Accra Ghana
| | | | - Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville FL
| | - Adam C. Levine
- and the Department of Emergency Medicine Brown University Providence RI
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Buonsenso D, Curatola A, Valentini P, Scialanga B, Toma P, Musolino AM. Chest ultrasound findings in children with confirmed pulmonary tuberculosis in low tuberculosis incidence country. Pediatr Pulmonol 2019; 54:1348-1350. [PMID: 31106507 DOI: 10.1002/ppul.24362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/21/2019] [Accepted: 04/26/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | - Paolo Toma
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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61
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Tsou P, Chen KP, Wang Y, Fishe J, Gillon J, Lee C, Deanehan JK, Kuo P, Yu DTY. Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta-analysis. Acad Emerg Med 2019; 26:1074-1088. [PMID: 31211896 DOI: 10.1111/acem.13818] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/21/2019] [Accepted: 06/12/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Childhood pneumonia is a leading cause of mortality worldwide. Growing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic alternative to chest x-ray for childhood pneumonia. However, it is unclear whether sonographer experience affects the diagnostic accuracy of LUS. We summarize the diagnostic accuracy of LUS for pneumonia and compare the performance between novice and advanced sonographers with a systematic review and meta-analysis. METHODS We searched PubMed and EMBASE from inception to February 2018 for eligible studies that evaluated the utility of LUS in children suspected of having pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory, and imaging results. We reported the study using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. We used QUADAS-2 to appraise the included studies' methodologic quality. We employed a random-effect bivariate model and a hierarchical summary receiver operating characteristic curve to evaluate LUS's performance characteristics. We conducted subgroup analyses and meta-regression based on level of sonographer training to summarize and compare LUS's diagnostic accuracy for pneumonia between novice (training ≤ 7 days) and advanced sonographers. RESULTS Twenty-five studies (n = 3,353) were included in the meta-analysis. For diagnosing pneumonia, LUS demonstrated an overall sensitivity of 0.94 (95% confidence interval [CI] = 0.89 to 0.97), specificity of 0.92 (95% CI = 0.78 to 0.98), positive likelihood ratio of 12.40 (95% CI = 4.00 to 38.10), and negative likelihood ratio of 0.07 (95% CI = 0.04 to 0.12), with an area under ROC curve of 0.97 (95% CI = 0.95 to 0.98). Meta-regression revealed a significant difference in the diagnostic accuracy for pneumonia for LUS between novice and advanced sonographers (p < 0.01). CONCLUSION LUS can accurately diagnose pneumonia in children. However, this test demonstrates operator-dependent variability, with more experienced sonographers having higher diagnostic accuracy. Further work on evidence-based educational methods to train novice sonographers in LUS is required.
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Affiliation(s)
- Po‐Yang Tsou
- Department of Pediatrics Driscoll Children's Hospital Corpus Christi TX
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Kenneth P. Chen
- Division of Pulmonary Critical Care, and Sleep Medicine, San Diego UCSD Medical Center San Diego CA
| | - Yu‐Hsun Wang
- Department of Pediatrics Driscoll Children's Hospital Corpus Christi TX
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Jennifer Fishe
- Department of Emergency Medicine University of Florida College of Medicine Jacksonville FL
| | - Jason Gillon
- Department of Pediatric Emergency Medicine University of Texas at Austin Dell Medical School Austin TX
| | - Chien‐Chang Lee
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
| | - Julia K. Deanehan
- Department of Pediatric Emergency Medicine Johns Hopkins School of Medicine Baltimore MD
| | - Pei‐Lun Kuo
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Daniel Ta Yo Yu
- Department of Pediatric Emergency Medicine Seattle Children's Hospital University of Washington Seattle WA
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62
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Perspectives on Point-of-Care Ultrasound Use in Pediatric Tropical Infectious Disease. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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63
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Ultrasound in the Limited-Resource Setting: A Systematic Qualitative Review. CURRENT RADIOLOGY REPORTS 2019. [DOI: 10.1007/s40134-019-0331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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64
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de Benedictis FM, Lanza C, Midulla F. Imaging diagnosis of pneumonia in children. J Pediatr 2019; 206:306. [PMID: 30580977 DOI: 10.1016/j.jpeds.2018.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 11/20/2022]
Affiliation(s)
| | - Cecilia Lanza
- Department of Radiological Sciences Azienda Ospedaliero-Universitaria Ancona, Italy
| | - Fabio Midulla
- Department of Pediatrics "Sapienza" University of Rome Rome, Italy
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65
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Sferrazza Papa S, Attanasi M, Di Pillo S, Mohn A, Chiarelli F, Pelliccia P. Reply. J Pediatr 2019; 206:306-307. [PMID: 30527751 DOI: 10.1016/j.jpeds.2018.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Angelika Mohn
- Department of Pediatrics Center of Excellence on Aging "G. D'Annunzio" University Foundation
| | - Francesco Chiarelli
- Department of Pediatrics Center of Excellence on Aging "G. D'Annunzio" University Foundation
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66
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Lenahan JL, Volpicelli G, Lamorte A, Jehan F, Bassat Q, Ginsburg AS. Multicentre pilot study evaluation of lung ultrasound for the management of paediatric pneumonia in low-resource settings: a study protocol. BMJ Open Respir Res 2018; 5:e000340. [PMID: 30622716 PMCID: PMC6307622 DOI: 10.1136/bmjresp-2018-000340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/22/2018] [Accepted: 10/19/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Pneumonia is the leading infectious cause of death among children under 5 years of age worldwide. However, pneumonia is challenging to diagnose. Lung ultrasound (LUS) is a promising diagnostic technology. Further evidence is needed to better understand the role of LUS as a tool for the diagnosis of childhood pneumonia in low-resource settings. METHODS AND ANALYSIS This study aims to pilot LUS in Mozambique and Pakistan and to generate evidence regarding the use of LUS as a diagnostic tool for childhood pneumonia. Children with cough <14 days with chest indrawing (n=230) and without chest indrawing (n=40) are enrolled. World Health Organization Integrated Management of Childhood Illness assessment is performed at enrolment, along with a chest radiograph and LUS examination. Respiratory and blood specimens are collected for viral and bacterial testing and biomarker assessment. Enrolled children are followed for 14 days (in person) and 30 days (phone call) post-enrolment with LUS examinations performed on Days 2, 6 and 14. Qualitative and quantitative data are also collected to assess feasibility, usability and acceptability of LUS among healthcare providers and caregivers. The primary outcome is LUS findings at enrolment with secondary outcomes including patient outcomes, repeat LUS findings, viral and bacterial test results, and patient status after 14 and 30 days of follow-up. ETHICS AND DISSEMINATION This trial was approved by the Western Institutional Review Board as well as local ethics review committees at each site. We plan to disseminate study results in peer-reviewed journals and international conferences. TRIAL REGISTRATION NUMBER NCT03187067.
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Affiliation(s)
- Jennifer L Lenahan
- International Programs, Save the Children Federation Inc, Fairfield, Connecticut, USA
| | | | | | - Fyezah Jehan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Amy Sarah Ginsburg
- International Programs, Save the Children Federation Inc, Fairfield, Connecticut, USA
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67
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Buhumaid RE, St-Cyr Bourque J, Shokoohi H, Ma IWY, Longacre M, Liteplo AS. Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. Am J Emerg Med 2018; 37:298-303. [PMID: 30413369 DOI: 10.1016/j.ajem.2018.10.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/28/2018] [Accepted: 10/28/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The differential diagnoses of patients presenting with chest pain (CP) and shortness of breath (SOB) are broad and non-specific. We aimed to 1) determine how use of point-of-care ultrasound (POCUS) impacted emergency physicians' differential diagnosis, and 2) evaluate the accuracy of POCUS when compared to chest radiograph (CXR) and composite final diagnosis. METHODS We conducted a prospective observational study in a convenience sample of patients presenting with CP and SOB to the Emergency Department (ED). Treating physicians selected possible diagnoses from a pre-indexed list of possible diagnoses of causes of CP and SOB. The final composite diagnosis from a chart review was determined as the reference standard for the diagnosis. The primary analysis involved calculations of sensitivity and specificity for POCUS identifiable diagnoses in detecting cause of CP and SOB. Additional comparative accuracy analysis with CXRs were conducted. RESULTS 128 patients with a mean age of 64 ± 17 years were included in the study. Using a reference standard of composite final diagnoses, POCUS had equal or higher specificity to CXR for all indications for which it was used, except for pneumonia. POCUS correctly identified all patients with pneumothorax, pleural effusion and pericardial effusion. In patients with a normal thoracic ultrasound, CXR never provided any actionable clinical information. Adding POCUS to the initial evaluation causes a significant narrowing of the differential diagnoses in which the median differential diagnosis from 5 (IQR 3-6) to 3 (IQR 2-4) p < 0.001. CONCLUSION In evaluation of patients with CP and SOB, POCUS is a highly feasible diagnostic test which can assist in narrowing down the differential diagnoses. In patients with a normal thoracic ultrasound, the added value of a CXR may be minimal.
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Affiliation(s)
- Rasha E Buhumaid
- Department of Emergency Medicine, Division of Emergency Ultrasound, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Julie St-Cyr Bourque
- Department of Emergency Medicine, Division of Emergency Ultrasound, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Hamid Shokoohi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mckenna Longacre
- Department of Anesthesia, Perioperative and Pain Medicine - Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew S Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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