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Guitart C, Bobillo-Perez S, Rodríguez-Fanjul J, Carrasco JL, Brotons P, López-Ramos MG, Cambra FJ, Balaguer M, Jordan I. Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia: a randomized clinical trial. Eur J Med Res 2024; 29:222. [PMID: 38581075 PMCID: PMC10998368 DOI: 10.1186/s40001-024-01712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/03/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP). METHODS Randomized, blinded, comparative effectiveness clinical trial. Children < 18y with suspected BP admitted to the PICU from September 2017 to December 2019, were included. PCT was determined at admission. Patients were randomized into the experimental group (EG) and control group (CG) if LUS or chest X-ray (CXR) were done as the first image test, respectively. Patients were classified: 1.LUS/CXR not suggestive of BP and PCT < 1 ng/mL, no antibiotics were recommended; 2.LUS/CXR suggestive of BP, regardless of the PCT value, antibiotics were recommended; 3.LUS/CXR not suggestive of BP and PCT > 1 ng/mL, antibiotics were recommended. RESULTS 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39-554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT < 1 ng/ml; 29/52 in the EG and 11/23 in the CG did not receive antibiotics. 2. In 101 patients, the image was suggestive of BP; 34/34 in the EG and 57/67 in the CG received antibiotics. Statistically significant differences between groups were observed when PCT resulted < 1 ng/ml (p = 0.01). 3. In 18 patients the image test was not suggestive of BP but PCT resulted > 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs. CONCLUSIONS Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management. CLINICAL TRIAL REGISTRATION NCT04217980.
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Affiliation(s)
- Carmina Guitart
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - José Luis Carrasco
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | - Pedro Brotons
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Francisco José Cambra
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
| | - Mònica Balaguer
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain.
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain.
| | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950, Esplugues de Llobregat, Barcelona, Spain
- Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950, Esplugues de Llogregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud (CIBERESP), Madrid, Spain
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Uguen J, Bouscaren N, Pastural G, Darrieux E, Lopes AA, Levy Y, Peipoch L. Lung ultrasound: A potential tool in the diagnosis of ventilator-associated pneumonia in pediatric intensive care units. Pediatr Pulmonol 2024; 59:758-765. [PMID: 38131518 DOI: 10.1002/ppul.26827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 11/11/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Ventilator-associated pneumonia (VAP) is a common healthcare-associated infection in pediatric intensive care unit (PICU), increasing mortality, antibiotics use and duration of ventilation and hospitalization. VAP diagnosis is based on clinical and chest X-ray (CXR) signs defined by the 2018 Center for Disease Control (gold standard). However, CXR induces repetitive patients' irradiation and technical limitations. This study aimed to investigate if lung ultrasound (LUS) can substitute CXR in the VAP diagnosis. METHODS A monocentric and prospective study was conducted in a French tertiary care hospital. Patients under 18-year-old admitted to PICU between November 2018 and July 2020 with invasive mechanical ventilation for more than 48 h were included. The studied LUS signs were consolidations, dynamic air bronchogram, subpleural consolidations (SPC), B-lines, and pleural effusion. The diagnostic values of each sign associated with clinical signs (cCDC) were compared to the gold standard approach. LUS, chest X-ray, and clinical score were performed daily. RESULTS Fifty-seven patients were included. The median age was 8 [3-34] months. Nineteen (33%) children developed a VAP. In patients with VAP, B-Lines, and consolidations were highly frequent (100 and 68.8%) and, associated with cCDC, were highly sensitive (100 [79-100] % and 88 [62-98] %, respectively) and specific (95.5 [92-98] % and 98 [95-99] %, respectively). Other studied signs, including SPC, showed high specificity (>97%) but low sensibility (<50%). CONCLUSION LUS seems to be a powerful tool for VAP diagnosis in children with a clinical suspicion, efficiently substituting CXR, and limiting children's exposure to ionizing radiations.
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Affiliation(s)
- Justine Uguen
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Nicolas Bouscaren
- Public Health Department, Inserm CIC 1410, University Hospital Center Saint Pierre, La Réunion, France
| | - Gaëlle Pastural
- Paediatric Radiology Department, University Hospital Center Félix Guyon, La Réunion, France
| | - Etienne Darrieux
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Anne-Aurélie Lopes
- Paediatric Emergency Department, University Hospital Robert-Debre, Sorbonne University, Paris, France
| | - Yael Levy
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
| | - Lise Peipoch
- Paediatric Intensive Care Unit, University Hospital Center Félix Guyon, La Réunion, France
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Chidini G, Raimondi F. Lung ultrasound for the sick child: less harm and more information than a radiograph. Eur J Pediatr 2024; 183:1079-1089. [PMID: 38127086 DOI: 10.1007/s00431-023-05377-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
In the realm of emergency medicine, the swift adoption of lung ultrasound (LU) has extended from the adult population to encompass pediatric and neonatal intensivists. LU stands out as a bedside, replicable, and cost-effective modality, distinct in its avoidance of ionizing radiations, a departure from conventional chest radiography. Recent years have witnessed a seamless adaptation of experiences gained in the adult setting to the neonatal and pediatric contexts, underscoring the versatility of bedside Point of care ultrasound (POCUS). This adaptability has proven reliable in diagnosing common pathologies and executing therapeutic interventions, including chest drainage, and central and peripheral vascular cannulation. The surge in POCUS utilization among neonatologists and pediatric intensivists is notable, spanning economically advanced Western nations with sophisticated, high-cost intensive care facilities and extending to low-income countries. Within the neonatal and pediatric population, POCUS has become integral for diagnosing and monitoring respiratory infections and chronic and acute lung pathologies. This, in turn, contributes to a reduction in radiation exposure during critical periods of growth, thereby mitigating oncological risks. Collaboration among various national and international societies has led to the formulation of guidelines addressing both the clinical application and regulatory aspects of operator training. Nevertheless, unified guidelines specific to the pediatric and neonatal population remain lacking, in contrast to the well-established protocols for adults. The initial application of POCUS in neonatal and pediatric settings centered on goal-directed echocardiography. Pivotal developments include expert statements in 2011, the UK consensus statement on echocardiography by neonatologists, and European training recommendations. The Australian Clinician Performed Ultrasound (CPU) program has played a crucial role, providing a robust academic curriculum tailored for training neonatologists in cerebral and cardiac assessment. Notably, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) recently disseminated evidence-based guidelines through an international panel, delineating the use and applications of POCUS in the pediatric setting. These guidelines are pertinent to any professional tending to critically ill children in routine or emergency scenarios. In light of the burgeoning literature, this paper will succinctly elucidate the methodology of performing an LU scan and underscore its primary indications in the neonatal and pediatric patient cohort. The focal points of this review comprise as follows: (1) methodology for conducting a lung ultrasound scan, (2) key ultrasonographic features characterizing a healthy lung, and (3) the functional approach: Lung Ultrasound Score in the child and the neonate. Conclusion: the aim of this review is to discuss the following key points: 1. How to perform a lung ultrasound scan 2. Main ultrasonographic features of the healthy lung 3. The functional approach: Lung Ultrasound Score in the child and the neonate What is Known: • Lung Ultrasound (LUS) is applied in pediatric and neonatal age for the diagnosis of pneumothorax, consolidation, and pleural effusion. • Recently, LUS has been introduced into clinical practice as a bedside diagnostic method for monitoring surfactant use in NARDS and lung recruitment in PARDS. What is New: • Lung Ultrasound (LUS) has proven to be useful in confirming diagnoses of pneumothorax, consolidation, and pleural effusion. • Furthermore, it has demonstrated effectiveness in monitoring the response to surfactant therapy in neonates, in staging the severity of bronchiolitis, and in PARDS.
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Affiliation(s)
- Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Anaesthesia, Intensive Care and Emergency Medicine Department, Milan, Italy.
| | - Francesco Raimondi
- Neonatal Intensive Care Unit, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
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Venkatakrishna SSB, Stadler JAM, Kilborn T, le Roux DM, Zar HJ, Andronikou S. Evaluation of the diagnostic performance of physician lung ultrasound versus chest radiography for pneumonia diagnosis in a peri-urban South African cohort. Pediatr Radiol 2024; 54:413-424. [PMID: 37311897 DOI: 10.1007/s00247-023-05686-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Lung ultrasound (US), which is radiation-free and cheaper than chest radiography (CXR), may be a useful modality for the diagnosis of pediatric pneumonia, but there are limited data from low- and middle-income countries. OBJECTIVES The aim of this study was to evaluate the diagnostic performance of non-radiologist, physician-performed lung US compared to CXR for pneumonia in children in a resource-constrained, African setting. MATERIALS AND METHODS Children under 5 years of age enrolled in a South African birth cohort study, the Drakenstein Child Health Study, who presented with clinically defined pneumonia and had a CXR performed also had a lung US performed by a study doctor. Each modality was reported by two readers, using standardized methodology. Agreement between modalities, accuracy (sensitivity and specificity) of lung US and inter-rater agreement were assessed. Either consolidation or any abnormality (consolidation or interstitial picture) was considered as endpoints. In the 98 included cases (median age: 7.2 months; 53% male; 69% hospitalized), prevalence was 37% vs. 39% for consolidation and 52% vs. 76% for any abnormality on lung US and CXR, respectively. Agreement between modalities was poor for consolidation (observed agreement=61%, Kappa=0.18, 95% confidence interval [95% CI]: - 0.02 to 0.37) and for any abnormality (observed agreement=56%, Kappa=0.10, 95% CI: - 0.07 to 0.28). Using CXR as the reference standard, sensitivity of lung US was low for consolidation (47%, 95% CI: 31-64%) or any abnormality (5%, 95% CI: 43-67%), while specificity was moderate for consolidation (70%, 95% CI: 57-81%), but lower for any abnormality (58%, 95% CI: 37-78%). Overall inter-observer agreement of CXR was poor (Kappa=0.25, 95% CI: 0.11-0.37) and was significantly lower than the substantial agreement of lung US (Kappa=0.61, 95% CI: 0.50-0.75). Lung US demonstrated better agreement than CXR for all categories of findings, showing a significant difference for consolidation (Kappa=0.72, 95% CI: 0.58-0.86 vs. 0.32, 95% CI: 0.13-0.51). CONCLUSION Lung US identified consolidation with similar frequency to CXR, but there was poor agreement between modalities. The significantly higher inter-observer agreement of LUS compared to CXR supports the utilization of lung US by clinicians in a low-resource setting.
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Affiliation(s)
| | - Jacob A M Stadler
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Tracy Kilborn
- Department of Pediatric Radiology, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa
| | - David M le Roux
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council (SAMRC), Unit On Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Yang Y, Wu Y, Zhao W. Comparison of lung ultrasound and chest radiography for detecting pneumonia in children: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:12. [PMID: 38263086 PMCID: PMC10804756 DOI: 10.1186/s13052-024-01583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is recommended as a reliable diagnostic alternative to chest X-ray (CXR) for detecting pneumonia in children. METHODS PubMed, Embase, and Cochrane Library databases were used to identify eligible studies from their inception until April 2023. The investigated diagnostic parameters included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC). RESULTS Twenty-six studies involving 3,401 children were selected for meta-analysis. The sensitivity, specificity, PLR, NLR, DOR, and AUC of LUS for detecting pneumonia in children were 0.95, 0.92, 12.31, 0.05, 108.53, and 0.98, respectively, while the sensitivity, specificity, PLR, NLR, DOR, and AUC of CXR were 0.92, 0.93, 24.63, 0.08, 488.54, and 0.99, respectively. The sensitivity of LUS was higher than that of CXR for detecting pneumonia in children (ratio: 1.03; 95% CI: 1.01-1.06; P = 0.018), whereas the DOR of LUS was significantly lower than that of CXR (ratio: 0.22; 95% CI: 0.06-0.85; P = 0.028). CONCLUSIONS This study found that the diagnostic performance of LUS was comparable to that of CXR for detecting pneumonia, and the sensitivity of LUS was superior to that of CXR.
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Affiliation(s)
- Yalong Yang
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China.
| | - Yuexuan Wu
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China
| | - Wen Zhao
- Ningxia Medical University, Yinchuan, 750004, China
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Zheng LL, Chen R, Zheng CH, Dai XJ, Zheng WD, Zhang JX. The correlation between lung ultrasound scores and outcomes of high-flow nasal cannula therapy in infants with severe pneumonia. BMC Pediatr 2024; 24:51. [PMID: 38229006 DOI: 10.1186/s12887-024-04522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE The study aimed to explore the effectiveness of bedside lung ultrasound (LUS) combined with the PaO2/FiO2 (P/F) ratio in evaluating the outcomes of high-flow nasal cannula (HFNC) therapy in infants with severe pneumonia. METHODS This retrospective study analyzed the clinical data of 150 infants diagnosed with severe pneumonia and treated with HFNC therapy at our hospital from January 2021 to December 2021. These patients were divided into two groups based on their treatment outcomes: the HFNC success group (n = 112) and the HFNC failure group (n = 38). LUS was utilized to evaluate the patients' lung conditions, and blood gas results were recorded for both groups upon admission and after 12 h of HFNC therapy. RESULTS At admission, no significant differences were observed between the two groups in terms of age, gender, respiratory rate, partial pressure of oxygen, and partial pressure of carbon dioxide. However, the P/F ratios at admission and after 12 h of HFNC therapy were significantly lower in the HFNC failure group (193.08 ± 49.14, 228.63 ± 80.17, respectively) compared to the HFNC success group (248.51 ± 64.44, 288.93 ± 57.17, respectively) (p < 0.05). Likewise, LUS scores at admission and after 12 h were significantly higher in the failure group (18.42 ± 5.3, 18.03 ± 5.36, respectively) than in the success group (15.09 ± 4.66, 10.71 ± 3.78, respectively) (p < 0.05). Notably, in the success group, both P/F ratios and LUS scores showed significant improvement after 12 h of HFNC therapy, a trend not observed in the failure group. Multivariate regression analysis indicated that lower P/F ratios and higher LUS scores at admission and after 12 h were predictive of a greater risk of HFNC failure. ROC analysis demonstrated that an LUS score > 20.5 at admission predicted HFNC therapy failure with an AUC of 0.695, a sensitivity of 44.7%, and a specificity of 91.1%. A LUS score > 15.5 after 12 h of HFNC therapy had an AUC of 0.874, with 65.8% sensitivity and 89.3% specificity. An admission P/F ratio < 225.5 predicted HFNC therapy failure with an AUC of 0.739, 60.7% sensitivity, and 71.1% specificity, while a P/F ratio < 256.5 after 12 h of HFNC therapy had an AUC of 0.811, 74.1% sensitivity, and 73.7% specificity. CONCLUSION Decreased LUS scores and increased P/F ratio demonstrate a strong correlation with successful HFNC treatment outcomes in infants with severe pneumonia. These findings may provide valuable support for clinicians in managing such cases.
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Affiliation(s)
- Li-Ling Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Rou Chen
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Chan-Hua Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Xiao-Juan Dai
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Wei-Da Zheng
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China
| | - Jia-Xiang Zhang
- Department of Pediatric Intensive Care Unit, Zhangzhou Affiliated Hospital, Fujian Medical University, 59 Shengli West Road, Xiangcheng District, Zhangzhou, China.
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Naber CE, Salt MD. POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound Techniques Ready for Prime-Time in Pediatric Critical Care. J Intensive Care Med 2024:8850666231224391. [PMID: 38193214 DOI: 10.1177/08850666231224391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Point-of-care ultrasound (POCUS) is an accessible technology that can identify and treat life-threatening pathology in real time without exposing children to ionizing radiation. We aim to review current evidence supporting the use of POCUS by pediatric intensivists with novice-level experience with bedside ultrasound. Current evidence supports the universal adoption of POCUS-guided internal jugular venous catheter placement and arterial line placement by pediatric critical care physicians. Focused cardiac ultrasound performed by PICU physicians who have completed appropriate training with quality assurance measures in place can identify life-threatening cardiac pathology in most children and important physiological changes in children with septic shock. POCUS of the lungs, pleural space, and diaphragm have great potential to provide valuable information at the bedside after validation of these techniques for use in the PICU with additional research. Based on currently available evidence, a generalizable and attainable POCUS educational platform for pediatric intensivists should include training in vascular access techniques and focused cardiac examination. A POCUS educational program should strive to establish credentialing and quality assurance programs that can be expanded when additional research validates the adoption of additional POCUS techniques by pediatric intensive care physicians.
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Affiliation(s)
- Catherine E Naber
- Emergency Medicine, Massachusetts General Hospital; Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael D Salt
- Massachusetts General Hospital; Pediatrics, Harvard Medical School, Boston, MA, USA
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Huerta-Calpe S, Salas B, Inarejos Clemente EJ, Guitart C, Balaguer M, Jordan I. Sono-Elastography: An Ultrasound Quantitative Non-Invasive Measurement to Guide Bacterial Pneumonia Diagnosis in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1335. [PMID: 37628334 PMCID: PMC10453076 DOI: 10.3390/children10081335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Lung ultrasound (LUS) is, at present, a standard technique for the diagnosis of acute lower respiratory tract infections (ALRTI) and other lung pathologies. Its protocolised use has replaced chest radiography and has led to a drastic reduction in radiation exposure in children. Despite its undeniable usefulness, there are situations in which certain quantitative measurements could provide additional data to differentiate the etiology of some pulmonary processes and thus adapt the treatment. Our research group hypothesises that several lung processes such pneumonia may lead to altered lung tissue stiffness, which could be quantified with new diagnostic tests such as lung sono-elastography (SE). An exhaustive review of the literature has been carried out, concluding that the role of SE for the study of pulmonary processes is currently scarce and poorly studied, particularly in pediatrics. The aim of this review is to provide an overview of the technical aspects of SE and to explore its potential usefulness as a non-invasive diagnostic technique for ALRTI in children by implementing an institutional image acquisition protocol.
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Affiliation(s)
- Sergi Huerta-Calpe
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (S.H.-C.); (C.G.); (M.B.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
| | - Bárbara Salas
- Radiology and Diagnostic Imaging Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (B.S.); (E.J.I.C.)
| | - Emilio J. Inarejos Clemente
- Radiology and Diagnostic Imaging Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (B.S.); (E.J.I.C.)
| | - Carmina Guitart
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (S.H.-C.); (C.G.); (M.B.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
| | - Mònica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (S.H.-C.); (C.G.); (M.B.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain; (S.H.-C.); (C.G.); (M.B.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, 08950 Barcelona, Spain
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Bessat C, Boillat-Blanco N, Albrich WC. The potential clinical value of pairing procalcitonin and lung ultrasonography to guide antibiotic therapy in patients with community-acquired pneumonia: a narrative review. Expert Rev Respir Med 2023; 17:919-927. [PMID: 37766614 DOI: 10.1080/17476348.2023.2254232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Lower respiratory tract infections (LRTIs) are among the most frequent infections and are prone to inappropriate antibiotic treatments. This results from a limited accuracy of diagnostic tools in identifying bacterial pneumonia. Lung ultrasound (LUS) has excellent sensitivity and specificity in diagnosing pneumonia. Additionally, elevated procalcitonin (PCT) levels correlate with an increased likelihood of bacterial infection. LUS and PCT appear to be complementary in identifying patients with bacterial pneumonia who are likely to benefit from antibiotics. AREAS COVERED This narrative review aims to summarize the current evidence for LUS to diagnose pneumonia, for PCT to guide antibiotic therapy and the clinical value of pairing both tools. EXPERT OPINION LUS has excellent diagnostic accuracy for pneumonia in different settings, regardless of the examiner's experience. PCT guidance safely reduces antibiotic prescription in LRTIs. The combination of both tools has demonstrated an enhanced accuracy in the diagnosis of pneumonia, including CAP in the ED and VAP in the ICU, but randomized controlled studies need to validate the clinical impact of a combined approach.
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Affiliation(s)
- Cécile Bessat
- Infectious Diseases Service, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Noémie Boillat-Blanco
- Infectious Diseases Service, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases & Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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10
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Vanderburg S, Kodikara I, Tharakan A, Sheng T, Gallis JA, Sellathurai M, Bodinayake C, Nagahawatte A, Wijayaratne GB, Woods CW, Tillekeratne LG, Riviello ED. A Practical Approach to Lung Ultrasound Training in Sri Lanka. ATS Sch 2023; 4:126-131. [PMID: 37538071 PMCID: PMC10394645 DOI: 10.34197/ats-scholar.2022-0072br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/11/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Sky Vanderburg
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, California
| | - Iroshani Kodikara
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
- Teaching Hospital Karapitiya, Galle, Sri Lanka
| | | | - Tianchen Sheng
- Duke University Global Health Institute, Durham, North Carolina
| | - John A. Gallis
- Duke University Global Health Institute, Durham, North Carolina
| | | | - Champica Bodinayake
- Teaching Hospital Karapitiya, Galle, Sri Lanka
- Duke University Global Health Institute, Durham, North Carolina
- Department of Medicine, and
| | - Ajith Nagahawatte
- Duke University Global Health Institute, Durham, North Carolina
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Gaya B. Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Chris W. Woods
- Duke University Global Health Institute, Durham, North Carolina
| | - L. Gayani Tillekeratne
- Duke University Global Health Institute, Durham, North Carolina
- Department of Medicine, and
| | - Elisabeth D. Riviello
- Beth Israel Deaconess Medical Center, and
- Harvard Medical School, Boston, Massachusetts
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11
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Ruscica A, Chen C, Ng L. Updates in pediatric ultrasound. Curr Opin Pediatr 2023; 35:324-330. [PMID: 36974449 DOI: 10.1097/mop.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW Point-of-care ultrasound (POCUS) has various diagnostic and therapeutic applications in the pediatric acute care setting that have an impact on clinical outcomes. RECENT FINDINGS POCUS can improve diagnostic efficiency and expedite management in pediatric patients who present to the emergency department with common complaints such as respiratory distress, abdominal pain, shock, and pain. SUMMARY Rapid advancements in POCUS have allowed it to become a powerful tool in pediatric care. As the clinical applications of ultrasound diversify, research is needed to evaluate impacts on healthcare outcomes, delivery, and costs.
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Affiliation(s)
- Alice Ruscica
- Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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12
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Taiorazova GB, Alimbayeva AR, Tanatarov SZ, Smailova ZK. A Modern Look at the Development of Intrauterine Pneumonia in Premature Newborns: Literature Review. Respir Physiol Neurobiol 2023; 314:104073. [PMID: 37178744 DOI: 10.1016/j.resp.2023.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Infectious diseases such as malaria, pneumonia, diarrhea and preventable neonatal diseases are common causes of death in children. Globally, neonatal mortality is 44% (2.9 million) annually, with up to 50% of babies dying within the first day of life. Pneumonia kills between 750000 and 1.2 million infants in the neonatal period each year in developing countries. Premature birth, pneumonia, and labor complications are common causes of neonatal mortality. The objective of the study is to present the general characteristics of congenital pneumonia, vitamin D deficiency and micronutrient deficiencies in premature infants. To date, numerous studies confirm the relationship between the inadequate supply of the body with macro- and microelements and the development of diseases of varying severity, including metabolic disorders. Based on this, primary screening, aimed at identifying metabolic disorders of macro- and microelements and further drug correction, should become the main concept for the management of patients in modern times.
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Affiliation(s)
- Gulnara B Taiorazova
- Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey Medical University, Semey, Republic of Kazakhstan.
| | - Aliya R Alimbayeva
- Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey Medical University, Semey, Republic of Kazakhstan
| | - Sayat Z Tanatarov
- Department of Аnesthesiology, Resuscitation and Narcology, Semey Medical University, Semey, Republic of Kazakhstan
| | - Zhanargul K Smailova
- Department of Biochemistry and Chemical Disciplines named after Doctor of Medical Sciences, Professor S.O. Tapbergenov, Semey Medical University, Semey, Republic of Kazakhstan
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13
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Jaworska J, Buda N, Kwaśniewicz P, Komorowska-Piotrowska A, Sands D. Lung Ultrasound in the Evaluation of Lung Disease Severity in Children with Clinically Stable Cystic Fibrosis: A Prospective Cross-Sectional Study. J Clin Med 2023; 12:jcm12093086. [PMID: 37176526 PMCID: PMC10179222 DOI: 10.3390/jcm12093086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
With the increasing longevity of cystic fibrosis (CF), there is a growing need to minimise exposure to ionising radiation in patients who undergo regular imaging tests while monitoring the course of the lung disease. This study aimed to define the role of lung ultrasounds (LUS) in the evaluation of lung disease severity in children with clinically stable CF. LUS was performed on 131 patients aged 5 weeks to 18 years (study group) and in 32 healthy children of an equivalent age range (control group). Additionally, an interobserver study was performed on 38 patients from the study group. In CF patients, the following ultrasound signs were identified: I-lines; Z-lines; single, numerous and confluent B-lines; Am-lines; small and major consolidations; pleural line abnormalities and small amounts of pleural fluid. The obtained results were evaluated against an original ultrasound score. LUS results were correlated with the results of chest X-ray (CXR) [very high], pulmonary function tests (PFTs) [high] and microbiological status [significant]. The interobserver study showed very good agreement between investigators. We conclude that LUS is a useful test in the evaluation of CF lung disease severity compared to routinely used methods. With appropriate standardisation, LUS is highly reproducible.
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Affiliation(s)
- Joanna Jaworska
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Piotr Kwaśniewicz
- Department of Diagnostic Imaging, Institute of Mother and Child, 01-211 Warsaw, Poland
| | | | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
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14
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Kazi S, Hernstadt H, Abo YN, Graham H, Palmer M, Graham SM. The utility of chest x-ray and lung ultrasound in the management of infants and children presenting with severe pneumonia in low-and middle-income countries: A pragmatic scoping review. J Glob Health 2022; 12:10013. [PMID: 36560909 PMCID: PMC9789364 DOI: 10.7189/jogh.12.10013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Chest x-ray (CXR) is commonly used (when available) to support clinical management decisions for child pneumonia and provide a reference standard for diagnosis in research studies. However, its diagnostic and technical limitations for both purposes are well recognised. Recent evidence suggests that lung ultrasound (LUS) may have diagnostic utility in pneumonia. This systematic scoping review of research on the utility of CXR and LUS in the management of severe childhood pneumonia aims to inform pragmatic guidelines for low- and middle-income countries (LMICs) and identify gaps in knowledge. Methods We included peer-reviewed studies published between 2000 and 2020 in infants and children aged from one month to nine years, presenting with severe pneumonia. CXR studies were limited to those from LMICs, while LUS studies included any geographic region. LUS and CXR articles were mapped into the following themes: indications, role in diagnosis, role in management, impact on outcomes, and practical considerations for LMIC settings. Results 85 articles met all eligibility criteria, including 27 CXR studies and 58 LUS studies. CXR studies were primarily observational and examined associations between radiographic abnormalities and pneumonia aetiology or outcomes. The most consistent finding was an association between CXR consolidation and risk of mortality. Difficulty obtaining quality CXR images and inter-reader variability in interpretation were commonly reported challenges. Research evaluating indications for CXR, role in management, and impact on patient outcomes was very limited. LUS studies primarily focused on diagnostic accuracy. LUS had higher sensitivity for identification of consolidation than CXR. There are gaps in knowledge regarding diagnostic criteria, as well as the practical utility of LUS in the diagnosis and management of pneumonia. Most LUS studies were conducted in HIC settings with experienced operators; however, small feasibility studies indicate that good inter-operator reliability may be achieved by training of novice clinicians in LMIC settings. Conclusions The available evidence does not support the routine use of CXR or LUS as essential tools in the diagnosis and initial management of severe pneumonia. Further evaluation is required to determine the clinical utility and feasibility of both imaging modalities in low-resource settings.
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Affiliation(s)
- Saniya Kazi
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia
| | | | - Yara-Natalie Abo
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Hamish Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
| | - Megan Palmer
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stephen M Graham
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia,Monash Health, Melbourne, Victoria, Australia,University of Melbourne Department of Paediatrics, Melbourne, Victoria, Australia
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15
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Kessler D, Dessie A, Kanjanauptom P, Vindas M, Ng L, Youssef MM, Birger R, Shaman J, Dayan P. Lack of Association Between a Quantified Lung Ultrasound Score and Illness Severity in Pediatric Emergency Department Patients With Acute Lower Respiratory Infections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3013-3022. [PMID: 35620855 DOI: 10.1002/jum.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) may help determine illness severity in children with acute lower respiratory tract infections (LRTI) but limited pediatric studies exist. Our objective was to determine the association between LUS findings and illness severity in children with LRTI. METHODS We conducted a prospective study of patients <20 years with LRTI. Trained investigators performed standardized LUS examinations of 12 regions. Blinded sonologists reviewed examinations for individual pathologic features and also calculated a Quantified Lung Ultrasound Score (QLUS). We defined focal severity as QLUS of ≥2 in ≥1 region, and diffuse severity as QLUS of ≥1 in ≥3 regions. The primary outcome was the Respiratory component of the Pediatric Early Warning Score (RPEWS), a 14-item scale measuring respiratory illness severity. Secondary outcomes included hospital admission, length of stay, supplemental oxygen, and antibiotic use. RESULTS We enrolled 85 patients with LRTIs, 46 (54%) whom were hospitalized (5.4% intensive care). Median RPEWS was 1 (interquartile range 2). Neither individual features on ultrasound nor total QLUS were associated with RPEWS, hospitalization, length of stay, or oxygen use. Mean RPEWS was similar for participants regardless of focal (1.46 versus 1.26, P = .57) or diffuse (1.47 versus 1.21, P = .47) severity findings, but those with focal or diffuse severity, or isolated consolidation, had greater antibiotic administration (P < .001). CONCLUSIONS In children with LRTI, neither individual features nor QLUS were associated with illness severity. Antibiotics were more likely in patients with either focal or diffuse severity or presence of consolidation on ultrasound.
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Affiliation(s)
- David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Panida Kanjanauptom
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marc Vindas
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Lorraine Ng
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mariam M Youssef
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Ruthie Birger
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Jeff Shaman
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Peter Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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16
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Hepworth-Warren KL, Nelson N, Dembek KA, Young KAS. Comparison of thoracic ultrasonography and thoracic radiography between healthy adult horses and horses with bacterial pneumonia using a novel, objective ultrasonographic scoring system. Front Vet Sci 2022; 9:991634. [PMID: 36311667 PMCID: PMC9608548 DOI: 10.3389/fvets.2022.991634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background Thoracic ultrasonography (TUS) is widely used in equine practice but comparison to radiography is limited in horses. Objectives To validate a novel, objective scoring system for TUS in adult horses and to compare ultrasonographic and radiographic findings. Animals 13 healthy horses and 9 with confirmed bacterial pneumonia Methods Prospective study in which TUS and radiography were performed on healthy horses and those with bacterial pneumonia confirmed by clinical signs and results of transtracheal wash analysis. Ultrasonography was scored utilizing a novel scoring system evaluating number of comet tail lesions, the presence or absence of pleural effusion and/or pulmonary consolidation in each intercostal space. Eighteen horses had thoracic radiographs taken that were scored by a board-certified radiologist utilizing a previously described system. Total scores were recorded and compared between control and diseased patients. Results/Findings Ultrasonographic scores were significantly higher in the diseased group (median= 126) than in the control group (median = 20, p = 0.01). Receiver operating characteristics (ROC) analysis identified a sensitivity of 66.7% (95% CI 0.417–1) and specificity of 92.3% (95% CI 0.462–1) for the ability of ultrasonography to identify bacterial pneumonia utilizing a TUS score cutoff of 37. Conclusions and clinical importance TUS had moderate sensitivity and high specificity for identification of bacterial pneumonia in adult horses. TUS appears to be an acceptable stand-alone imaging modality for diagnosis of bacterial pneumonia in horses when radiography is not practical.
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Affiliation(s)
- Kate L. Hepworth-Warren
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States,*Correspondence: Kate L. Hepworth-Warren
| | - Nathan Nelson
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Katarzyna A. Dembek
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| | - Kimberly A. S. Young
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
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17
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Omran A, Awad H, Ibrahim M, El-Sharkawy S, Elfiky S, Rezk AR. Lung Ultrasound and Neutrophil Lymphocyte Ratio in Early Diagnosis and Differentiation between Viral and Bacterial Pneumonia in Young Children. CHILDREN 2022; 9:children9101457. [PMID: 36291392 PMCID: PMC9600537 DOI: 10.3390/children9101457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022]
Abstract
Lung ultrasound (LUS) is a crucial diagnostic tool for identifying pneumonia in the pediatric age group. However, it plays a limited role in the early distinction between viral and bacterial pneumonia in children. The objectives of our study were to determine if LUS and the neutrophil-lymphocyte ratio (NLR) were useful in identifying and distinguishing between viral and bacterial pneumonia in Egyptian children under the age of two. Within the first 12 h of being admitted to our department, 52 children with clinical symptoms and signs suggestive of community-acquired pneumonia (CAP) underwent LUS and the NLR. LUS and the NLR strongly differentiated children with viral from those with bacterial pneumonia. For the early diagnosis and differentiation between viral and bacterial pneumonia in young Egyptian children, LUS was proven to be a noninvasive and reliable method. Combining the NLR with LUS increased the diagnostic accuracy when evaluating children suspected of having pneumonia.
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Affiliation(s)
- Ahmed Omran
- Department of Pediatrics & Neonatology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: ; Tel.: +20-10067-76278
| | - Heba Awad
- Department of Pediatrics & Neonatology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Mostafa Ibrahim
- Department of Radiodiagnosis, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Sonya El-Sharkawy
- Department of Pediatrics & Neonatology, Faculty of Medicine, Port Said University, Port Said 42526, Egypt
| | - Samar Elfiky
- Department of Pediatrics & Neonatology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ahmed R. Rezk
- Department of Pediatrics, Ain Shams University, Cairo 11566, Egypt
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18
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Checkley W, Hossen S, McCollum ED, Pervaiz F, Miele CH, Chavez MA, Moulton LH, Simmons N, Roy AD, Chowdhury NH, Ahmed S, Begum N, Quaiyum A, Santosham M, Baqui AH. Effectiveness of the 10-valent pneumococcal conjugate vaccine on pediatric pneumonia confirmed by ultrasound: a matched case-control study. Respir Res 2022; 23:198. [PMID: 35915495 PMCID: PMC9341060 DOI: 10.1186/s12931-022-02115-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Bangladesh introduced the 10-valent pneumococcal conjugate vaccine (PCV10) for children aged < 1 year in March 2015. Previous vaccine effectiveness (VE) studies for pneumonia have used invasive pneumococcal disease or chest X-rays. None have used ultrasound. We sought to determine the VE of PCV10 against sonographically-confirmed pneumonia in three subdistrict health complexes in Bangladesh. Methods We conducted a matched case–control study between July 2015 and September 2017 in three subdistricts of Sylhet, Bangladesh. Cases were vaccine-eligible children aged 3–35 months with sonographically-confirmed pneumonia, who were matched with two types of controls by age, sex, week of diagnosis, subdistrict health complex (clinic controls) or distance from subdistrict health complex (community controls) and had an illness unlikely due to Streptococcus pneumoniae (clinic controls) or were healthy (community controls). VE was measured using multivariable conditional logistic regression. Results We evaluated 8926 children (average age 13.3 months, 58% boys) with clinical pneumonia by ultrasound; 2470 had pneumonia with consolidations ≥ 1 cm; 1893 pneumonia cases were matched with 4238 clinic controls; and 1832 were matched with 3636 community controls. VE increased with the threshold used for consolidation size on ultrasound: the adjusted VE of ≥ 2 doses vs. non-recipients of PCV10 against pneumonia increased from 15.8% (95% CI 1.6–28.0%) for consolidations ≥ 1 cm to 29.6% (12.8–43.2%) for consolidations ≥ 1.5 cm using clinic controls and from 2.7% (− 14.2–17.2%) to 23.5% (4.4–38.8%) using community controls, respectively. Conclusions PCV10 was effective at reducing sonographically-confirmed pneumonia in children aged 3–35 months of age when compared to unvaccinated children. VE increased with the threshold used for consolidation size on ultrasound in clinic and community controls alike. This study provides evidence that lung ultrasound is a useful alternative to chest X-ray for case–control studies evaluating the effectiveness of vaccines against pneumonia.
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Affiliation(s)
- William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA. .,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. .,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Eric D McCollum
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Farhan Pervaiz
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Catherine H Miele
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Miguel A Chavez
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St, Room 555, Baltimore, MD, 21287, USA
| | - Lawrence H Moulton
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Nicole Simmons
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | | | | | - Nazma Begum
- Johns Hopkins University -Bangladesh, Dhaka, Bangladesh
| | - Abdul Quaiyum
- Johns Hopkins University -Bangladesh, Dhaka, Bangladesh
| | - Mathuram Santosham
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, USA
| | - Abdullah H Baqui
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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19
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Persson JN, Kim JS, Good RJ. Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:151-173. [PMID: 36277259 PMCID: PMC9264295 DOI: 10.1007/s40746-022-00250-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 12/26/2022]
Abstract
Purpose of Review Recent Findings Summary Supplementary Information
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Affiliation(s)
- Jessica N. Persson
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
- Division of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
| | - John S. Kim
- Division of Cardiology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
| | - Ryan J. Good
- Division of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 East 16th, Avenue, Box 100, Aurora, CO 80045 USA
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20
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Mor Conejo M, Guitart Pardellans C, Fresán Ruiz E, Penela Sánchez D, Cambra Lasaosa FJ, Jordan Garcia I, Balaguer Gargallo M, Pons-Òdena M. Lung Recruitment Maneuvers Assessment by Bedside Lung Ultrasound in Pediatric Acute Respiratory Distress Syndrome. CHILDREN 2022; 9:children9060789. [PMID: 35740726 PMCID: PMC9222064 DOI: 10.3390/children9060789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022]
Abstract
The use of recruitment maneuvers (RMs) is suggested to improve severe oxygenation failure in patients with acute respiratory distress syndrome (ARDS). Lung ultrasound (LUS) is a non-invasive, safe, and easily repeatable tool. It could be used to monitor the lung recruitment process in real-time. This paper aims to evaluate bedside LUS for assessing PEEP-induced pulmonary reaeration during RMs in pediatric patients. A case of a child with severe ARDS due to Haemophilus influenzae infection is presented. Due to his poor clinical, laboratory, and radiological evolution, he was placed on venovenous extracorporeal membrane oxygenation (ECMO). Despite all measures, severe pulmonary collapse prevented proper improvement. Thus, RMs were indicated, and bedside LUS was successfully used for monitoring and assessing lung recruitment. The initial lung evaluation before the maneuver showed a tissue pattern characterized by a severe loss of lung aeration with dynamic air bronchograms and multiple coalescent B-lines. While raising a PEEP of 30 mmH2O, LUS showed the presence of A-lines, which was considered a predictor of reaeration in response to the recruitment maneuver. The LUS pattern could be used to assess modifications in the lung aeration, evaluate the effectiveness of RMs, and prevent lung overdistension.
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Affiliation(s)
- Mireia Mor Conejo
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
| | - Carmina Guitart Pardellans
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Elena Fresán Ruiz
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Daniel Penela Sánchez
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
| | - Francisco José Cambra Lasaosa
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Iolanda Jordan Garcia
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Mònica Balaguer Gargallo
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Correspondence: (M.B.G.); (M.P.-Ò.)
| | - Martí Pons-Òdena
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain; (M.M.C.); (C.G.P.); (E.F.R.); (D.P.S.); (F.J.C.L.); (I.J.G.)
- Immune and Respiratory Dysfunction Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Correspondence: (M.B.G.); (M.P.-Ò.)
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Diagnostic Performance of Antigen Rapid Diagnostic Tests, Chest Computed Tomography, and Lung Point-of-Care-Ultrasonography for SARS-CoV-2 Compared with RT-PCR Testing: A Systematic Review and Network Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12061302. [PMID: 35741112 PMCID: PMC9222155 DOI: 10.3390/diagnostics12061302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/04/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: The comparative performance of various diagnostic methods for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remains unclear. This study aimed to investigate the comparison of the 3 index test performances of rapid antigen diagnostic tests (RDTs), chest computed tomography (CT), and lung point-of-care-ultrasonography (US) with reverse transcription-polymerase chain reaction (RT-PCR), the reference standard, to provide more evidence-based data on the appropriate use of these index tests. (2) Methods: We retrieved data from electronic literature searches of PubMed, Cochrane Library, and EMBASE from 1 January 2020, to 1 April 2021. Diagnostic performance was examined using bivariate random-effects diagnostic test accuracy (DTA) and Bayesian network meta-analysis (NMA) models. (3) Results: Of the 3992 studies identified in our search, 118 including 69,445 participants met our selection criteria. Among these, 69 RDT, 38 CT, and 15 US studies in the pairwise meta-analysis were included for DTA with NMA. CT and US had high sensitivity of 0.852 (95% credible interval (CrI), 0.791–0.914) and 0.879 (95% CrI, 0.784–0.973), respectively. RDT had high specificity, 0.978 (95% CrI, 0.960–0.996). In accuracy assessment, RDT and CT had a relatively higher than US. However, there was no significant difference in accuracy between the 3 index tests. (4) Conclusions: This meta-analysis suggests that, compared with the reference standard RT-PCR, the 3 index tests (RDTs, chest CT, and lung US) had similar and complementary performances for diagnosis of SARS-CoV-2 infection. To manage and control COVID-19 effectively, future large-scale prospective studies could be used to obtain an optimal timely diagnostic process that identifies the condition of the patient accurately.
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22
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Rodríguez-Contreras FJ, Calvo-Cebrián A, Díaz-Lázaro J, Cruz-Arnés M, León-Vázquez F, del Carmen Lobón-Agúndez M, Palau-Cuevas FJ, Henares-García P, Gavilán-Martínez F, Fernández-Plaza S, Prieto-Zancudo C. Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study. Ann Fam Med 2022; 20:227-236. [PMID: 35606120 PMCID: PMC9199040 DOI: 10.1370/afm.2796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated whether lung ultrasound (US) performed in primary care is useful and feasible for diagnosing community-acquired pneumonia (CAP) compared with chest radiography, as most previous research has been conducted in hospital settings. METHODS We undertook a prospective observational cohort study of lung US performed in 12 primary care centers. Patients aged 5 years and older with symptoms suggesting CAP were examined with lung US (by 21 family physicians and 7 primary care pediatricians) and chest radiograph on the same day. We compared lung US findings with the radiologist's chest radiograph report as the reference standard, given that the latter is the most common imaging test performed for suspected CAP in primary care. The physicians had varied previous US experience, but all received a 5-hour lung US training program. RESULTS The study included 82 patients. Compared with chest radiography, positive lung US findings (consolidation measuring >1 cm or a focal/asymmetrical B-lines pattern) showed a sensitivity of 87.8%, a specificity of 58.5%, a positive likelihood-ratio of 2.12, and a negative likelihood-ratio of 0.21. Findings were similar regardless of the physicians' previous US training or experience. We propose a practical algorithm whereby patients having consolidation measuring greater than 1 cm or normal findings on lung US could skip chest radiography, whereas patients with a B-lines pattern without consolidation (given its low specificity) would need chest radiography to ensure appropriate management. Lung US was generally performed in 10 minutes or less. CONCLUSION Point-of-care lung US in primary care could be useful for investigating suspected CAP (avoiding chest radiography in most cases) and is likely feasible in daily practice, as short training programs appear sufficient and little time is needed to perform the scan.
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Affiliation(s)
| | - Antonio Calvo-Cebrián
- CORRESPONDING AUTHOR Antonio Calvo-Cebrián Centro de Salud Galapagar Avda Víctimas del Terrorismo 3 28260 Galapagar, Madrid, Spain
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Significance of Sonographic Subcentimeter, Subpleural Consolidations in Pediatric Patients Evaluated for Pneumonia. J Pediatr 2022; 243:193-199.e2. [PMID: 34968499 DOI: 10.1016/j.jpeds.2021.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the rates of radiographic pneumonia and clinical outcomes of children with suspected pneumonia and subcentimeter, subpleural consolidations on point-of-care lung ultrasound. STUDY DESIGN We enrolled a prospective convenience sample of children aged 6 months to 18 years undergoing chest radiography (CXR) for pneumonia evaluation in a single tertiary-care pediatric emergency department. Point-of-care lung ultrasound was performed by an emergency medicine physician with subsequent expert review. We determined rates of radiographic pneumonia and clinical outcomes in the children with subcentimeter, subpleural consolidations, stratified by the presence of larger (>1 cm) sonographic consolidations. The children were followed prospectively for 2 weeks to identify a delayed diagnosis of pneumonia. RESULTS A total of 188 patients, with a median age of 5.8 years (IQR, 3.5-11.0 years), were evaluated. Of these patients, 62 (33%) had subcentimeter, subpleural consolidations on lung ultrasound, and 23 (37%) also had larger (>1 cm) consolidations. Patients with subcentimeter, subpleural consolidations and larger consolidations had the highest rates of definite radiographic pneumonia (61%), compared with 21% among children with isolated subcentimeter, subpleural consolidations. Overall, 23 children with isolated subcentimeter, subpleural consolidations (59%) had no evidence of pneumonia on CXR. Among 16 children with isolated subcentimeter, subpleural consolidations and not treated with antibiotics, none had a subsequent pneumonia diagnosis within the 2-week follow-up period. CONCLUSIONS Children with subcentimeter, subpleural consolidations often had radiographic pneumonia; however, this occurred most frequently when subcentimeter, subpleural consolidations were identified in combination with larger consolidations. Isolated subcentimeter, subpleural consolidations in the absence of larger consolidations should not be viewed as synonymous with pneumonia; CXR may provide adjunctive information in these cases.
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24
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Guitart C, Rodríguez-Fanjul J, Bobillo-Perez S, Carrasco JL, Inarejos Clemente EJ, Cambra FJ, Balaguer M, Jordan I. An algorithm combining procalcitonin and lung ultrasound improves the diagnosis of bacterial pneumonia in critically ill children: The PROLUSP study, a randomized clinical trial. Pediatr Pulmonol 2022; 57:711-723. [PMID: 34921717 DOI: 10.1002/ppul.25790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Lung ultrasound (LUS) and procalcitonin (PCT) are independently used to improve accuracy when diagnosing lung infections. The aim of the study was to evaluate the accuracy of a new algorithm combining LUS and PCT for the diagnosis of bacterial pneumonia. METHODS Randomized, blinded, comparative effectiveness clinical trial. Children <18 years old with suspected pneumonia admitted to pediatric intensive care unit were included, and randomized into experimental group (EG) or control group (CG) if LUS or chest X-Ray (CXR) were done as the first pulmonary image, respectively. PCT was determined. In patients with bacterial pneumonia, sensitivity, specificity, and predictive values of LUS, CXR, and of both combined with PCT were analyzed and compared. Concordance between the final diagnosis and the diagnosis concluded through the imaging test was assessed. RESULTS A total of 194 children, with a median age of 134 (interquartile range [IQR]: 39-554) days, were enrolled, 96 randomized into the EG and 98 into the CG. Bacterial pneumonia was diagnosed in 97 patients. Sensitivity and specificity for bacterial pneumonia diagnosis were 78% (95% confidence interval [CI]: 70-85) and 98% (95% CI: 93-99) for LUS, 85% (95% CI: 78-90) and 53% (95% CI: 43-62) for CXR, 90% (95% CI: 83-94) and 85% (95% CI: 76-91) when combining LUS and PCT, and 95% (95% CI: 90-98) and 41% (95% CI: 31-52) when combining CXR and PCT. The positive predictive value for LUS and PCT was 88% (95% C:I 79%-93%) versus 68% (95% CI: 60-75) for CXR and PCT. The concordance between the final diagnosis and LUS had a kappa value of 0.69 (95% CI: 0.62-0.75) versus 0.34 (95% CI: 0.21-0.45) for CXR, (p < 0.001). CONCLUSIONS The combination of LUS and PCT presented a better accuracy for bacterial pneumonia diagnosis than combining CXR and PCT. Therefore, its implementation could be a reliable tool for pneumonia diagnosis in critically ill children.
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Affiliation(s)
- Carmina Guitart
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit, Department of Pediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Sara Bobillo-Perez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - José L Carrasco
- Department of Basic Clinical Practice, University of Barcelona, Barcelona, Spain
| | | | - Francisco J Cambra
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Mònica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, Barcelona, Spain
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Don M, Fiotti N, Bizjak R, Guerra M, Nicolini G, Barbi E, Toller I, Narducci F, Tortorella ML, Dragovic D, Copetti R, Barillari A. Multicentre study supports the use of lung ultrasound in diagnosing paediatric community-acquired pneumonia. Acta Paediatr 2022; 111:401-402. [PMID: 34599618 DOI: 10.1111/apa.16131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Massimiliano Don
- Pediatric Care Unit Sant'Antonio General Hospital San Daniele del Friuli Italy
| | - Nicola Fiotti
- Department of Medical Surgical and Health Sciences Unit of Clinica Medica University of Trieste Trieste Italy
| | - Ruben Bizjak
- Pediatric Care Unit Sempeter pri Gorici General Hospital Nova Gorica Slovenia
| | - Mattia Guerra
- Department of Clinical and Experimental Medical Sciences Unit of Paediatrics University Hospital of Udine Udine Italy
| | | | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
- Department of Medical Surgical and Health Sciences Unit of Clinica Pediatrica University of Trieste Trieste Italy
| | - Ingrid Toller
- Pediatric Care Unit Sant'Antonio Abate General Hospital Tolmezzo Italy
| | | | | | - Danica Dragovic
- Pediatric Care Unit San Polo General Hospital Monfalcone Italy
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26
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Ciuca IM, Dediu M, Pop LL. Pediatric pneumonia (PedPne) lung ultrasound score and inflammatory markers: A pilot study. Pediatr Pulmonol 2022; 57:576-582. [PMID: 34786878 DOI: 10.1002/ppul.25760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/17/2021] [Accepted: 11/09/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Pneumonia is the principal cause of death among children worldwide. Lung ultrasound (LUS) is a reliable tool for the diagnosis and assessment of community-acquired pneumonia in children. Furthermore, objective parameters, including the pneumonia LUS score, might be useful for pneumonia monitoring. Thus, our aim was to present a newly developed LUS score for pediatric pneumonia (PedPne) and evaluate its relationship with commonly assessed inflammatory markers. METHODS Children referred to the Pediatric Pneumology Clinic between September 2017 and February 2018 with suspected pneumonia were screened for eligibility for inclusion in the study and informed consent was obtained. In addition to clinical assessment, LUS was performed during consultation, and inflammatory biomarkers, including C-reactive protein level, erythrocyte sedimentation rate (ESR), and leukocyte count, were measured in all inpatients. An LUS score for pneumonia and pleurisy in children (pediatric pneumonia lung ultrasound score [PedPne LUS]) was subsequently developed. Chest radiography (CXR) was also performed according to local guidelines for pneumonia diagnosis. Spearman's correlation test was used to evaluate the correlation between the PedPne score and inflammatory markers. RESULTS A total of 217 patients were screened, of which 64 patients diagnosed with consolidated pneumonia were included in this study. The median PedPne LUS score of the included patients was 8.02, which was consistent with the consolidations detected on LUS and confirmed by CXR. A very strong positive correlation was found between the LUS PedPne score and C-reactive protein and ESR, and a good correlation was found with the leukocyte count. CONCLUSION The LUS pneumonia score is a reliable parameter for the evaluation of pneumonia, and shows a strong correlation with inflammatory biomarkers. The PedPne LUS score is a potential noninvasive surrogate parameter of inflammation in pediatric pneumonia.
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Affiliation(s)
- Ioana M Ciuca
- Department of Pediatric, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timișoara, Romania
| | - Mihaela Dediu
- Department of Pediatric, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timișoara, Romania
| | - Liviu L Pop
- Department of Pediatric, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timișoara, Romania
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27
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Abd Wahab M, Eddie EA, Ibrahim Ahmad UQA, Shafie H, Shaikh Abd Karim SB, Abdull Wahab SF. Lung Ultrasonography for COVID-19 Patients in Out of Hospital Settings. J Ultrasound 2022; 25:475-482. [PMID: 35032294 PMCID: PMC8760565 DOI: 10.1007/s40477-021-00609-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/06/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The portability of a hand-held ultrasound allows the health care worker to conduct lung ultrasound in out-of-hospital setting. It is used as a tool to conduct staging and triaging for COVID-19 patients. This study evaluated the utilization of lung ultrasound in an out-of-hospital setting versus chest x-rays in detecting and staging of COVID-19 patients with pneumonia. METHODS The study was conducted among COVID-19 subjects at an out-of-hospital setting whereby lung ultrasound was done and subsequently chest x-rays were taken after being admitted to the health care facilities. Lung ultrasound findings were reviewed by emergency physicians, while the chest x-rays were reviewed by radiologists. Radiologists were blinded by the patients' lung ultrasound findings and clinical conditions. The analysis of the agreement between the lung ultrasound findings and chest x-rays was conducted. RESULTS A total of 261 subjects were recruited. LUS detected pulmonary infiltrative changes in more stage 3 COVID-19 subjects in comparison to chest x-rays. Multiple B-lines were the predominant findings at the right lower anterior, posterior and lateral zones. Interstitial consolidations and ground glass opacities were the predominant descriptive findings in chest x-rays. However, there was no agreement between lung ultrasound and chest x-ray findings in detecting COVID-19 pneumonia as the Cohen's Kappa coefficient was 0.08 (95% CI 0.06-0.22, p = 0.16). CONCLUSION The diagnostic imaging and staging of COVID-19 patients using lung ultrasound in out-of-hospital settings showed LUS detected lung pleural disease more often than CXR for stage 3 COVID-19 patients.
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Affiliation(s)
- Mahathar Abd Wahab
- Department of Emergency and Trauma, Hospital Kuala Lumpur, Federal Territories Kuala Lumpur, Kuala Lumpur, Malaysia.
| | - Elisa A Eddie
- Department of Emergency and Trauma, Hospital Kuala Lumpur, Federal Territories Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Hidayah Shafie
- Department of Emergency and Trauma, Hospital Kuala Lumpur, Federal Territories Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Shaik Farid Abdull Wahab
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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28
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Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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A training plan to implement lung ultrasound for diagnosing pneumonia in children. Pediatr Res 2022; 92:1115-1121. [PMID: 34969992 PMCID: PMC9586858 DOI: 10.1038/s41390-021-01928-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 11/17/2021] [Accepted: 12/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lung ultrasound (LUS) for critical patients requires trained operators to perform them, though little information exists on the level of training required for independent practice. The aims were to implement a training plan for diagnosing pneumonia using LUS and to analyze the inter-observer agreement between senior radiologists (SRs) and pediatric intensive care physicians (PICPs). METHODS Prospective longitudinal and interventional study conducted in the Pediatric Intensive Care Unit of a tertiary hospital. Following a theoretical and practical training plan regarding diagnosing pneumonia using LUS, the concordance between SRs and the PICPs on their LUS reports was analyzed. RESULTS Nine PICPs were trained and tested on both theoretical and practical LUS knowledge. The mean exam mark was 13.5/15. To evaluate inter-observer agreement, a total of 483 LUS were performed. For interstitial syndrome, the global Kappa coefficient (K) was 0.51 (95% CI 0.43-0.58). Regarding the presence of consolidation, K was 0.67 (95% CI 0.53-0.78), and for the consolidation pattern, K was 0.82 (95% CI 0.79-0.85), showing almost perfect agreement. CONCLUSIONS Our training plan allowed PICPs to independently perform LUS and might improve pneumonia diagnosis. We found a high inter-observer agreement between PICPs and SRs in detecting the presence and type of consolidation on LUS. IMPACT Lung ultrasound (LUS) has been proposed as an alternative to diagnose pneumonia in children. However, the adoption of LUS in clinical practice has been slow, and it is not yet included in general clinical guidelines. The results of this study show that the implementation of a LUS training program may improve pneumonia diagnosis in critically ill patients. The training program's design, implementation, and evaluation are described. The high inter-observer agreement between LUS reports from the physicians trained and expert radiologists encourage the use of LUS not only for pneumonia diagnosis, but also for discerning bacterial and viral patterns.
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31
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Stoicescu ER, Ciuca IM, Iacob R, Iacob ER, Marc MS, Birsasteanu F, Manolescu DL, Iacob D. Is Lung Ultrasound Helpful in COVID-19 Neonates?-A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11122296. [PMID: 34943533 PMCID: PMC8699875 DOI: 10.3390/diagnostics11122296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19. Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-19′. Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper. Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.
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Affiliation(s)
- Emil Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Ioana Mihaiela Ciuca
- Pediatric Department, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Correspondence:
| | - Roxana Iacob
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
| | - Emil Radu Iacob
- Department of Pediatric Surgery, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Monica Steluta Marc
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Florica Birsasteanu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
| | - Diana Luminita Manolescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (E.R.S.); (R.I.); (F.B.); (D.L.M.)
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babeș’ University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Daniela Iacob
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania;
- Department of Neonatology, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Caroselli C, Blaivas M, Falzetti S. Diagnostic Imaging in Newborns, Children and Adolescents Infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Is There a Realistic Alternative to Lung High-Resolution Computed Tomography (HRCT) and Chest X-Rays? A Systematic Review of the Literature. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3034-3040. [PMID: 34429231 PMCID: PMC8302856 DOI: 10.1016/j.ultrasmedbio.2021.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/16/2021] [Accepted: 07/19/2021] [Indexed: 05/03/2023]
Abstract
Chest computed tomography has been frequently used to evaluate patients with potential coronavirus disease 2019 (COVID-19) infection. However, this may be particularly risky for pediatric patients owing to high doses of ionizing radiation. We sought to evaluate COVID-19 imaging options in pediatric patients based on the published literature. We performed an exhaustive literature review focusing on COVID-19 imaging in pediatric patients. We used the search terms "COVID-19," "SARS-CoV2," "coronavirus," "2019-nCoV," "Wuhan virus," "lung ultrasound (LUS)," "sonography," "lung HRCT," "children," "childhood" and "newborn" to query the online databases PubMed, Medical Subject Headings (MeSH), Embase, LitCovid, the World Health Organization COVID-19 database and Medline Bireme. Articles meeting the inclusion criteria were included in the analysis and review. We identified only seven studies using lung ultrasound (LUS) to diagnose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in newborns and children. The studies evaluated small numbers of patients, and only 6% had severe or critical illness associated with COVID-19. LUS showed the presence of B-lines in 50% of patients, sub-pleural consolidation in 43.18%, pleural irregularities in 34.09%, coalescent B-lines and white lung in 25%, pleural effusion in 6.82% and thickening of the pleural line in 4.55%. We found 117 studies describing the use of chest X-ray or chest computed tomography in pediatric patients with COVID-19. The proportion of those who were severely or critically ill was similar to that in the LUS study population. Our review indicates that use of LUS should be encouraged in pediatric patients, who are at highest risk of complications from medical ionizing radiation. Increased use of LUS may be of particularly high impact in under-resourced areas, where access to chest computed tomography may be limited.
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Affiliation(s)
- Costantino Caroselli
- Acute Geriatric Unit, Geriatric Emergency Room and Aging Research Centre, IRCCS INRCA, Ancona, Italy.
| | - Michael Blaivas
- Department of Emergency Medicine. St Francis Hospital, Columbus, GA, USA; Department of Medicine, University of South Carolina School of Medicine, Location
| | - Sara Falzetti
- School of Specialization in Geriatrics, School of Medicine and Surgery, University of Ancona, Ancona, Italy
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Biagi C, Scarpini S, Paleari C, Fabi M, Dondi A, Gabrielli L, Gennari M, Lanari M, Pierantoni L. Impact of Guidelines Publication on Acute Bronchiolitis Management: 10-Year Experience from a Tertiary Care Center in Italy. Microorganisms 2021; 9:2221. [PMID: 34835347 PMCID: PMC8625287 DOI: 10.3390/microorganisms9112221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 11/16/2022] Open
Abstract
Bronchiolitis is the most common lower respiratory tract infection in infants. According to evidence-based guidelines, diagnosis is clinical, there is no need for routine use of laboratory or instrumental tests and therapy is primarily supportive, based on oxygen and adequate fluid supplementation. Nevertheless, unnecessary diagnostic tests and pharmacological treatments are still very common. The aim of this retrospective cohort study was to evaluate how the management of bronchiolitis has changed in the last ten years in a Tertiary Care Center in Italy, assessing adherence to national guidelines. Considering the publication of the Italian inter-society consensus document in 2014, we compared patients admitted in the prior four epidemic seasons with patients admitted in the latter six epidemic seasons. The comparison between the two groups showed a significant reduction in the prescription of systemic corticosteroids (58.9% vs. 41.8%, p < 0.001), nebulized epinephrine (73.8% vs. 38.3%, p < 0.001) and antibiotics (59.5% vs. 42.3%, p < 0.001), together with a drastic decrease in the use of chest X-ray (92.2% vs. 54.4%, p < 0.001). On the contrary, the use of inhaled salbutamol remained substantially stable over time (39.4% vs. 37.6%, p = 0.505). Despite the encouraging results, further efforts are needed to limit the prescription of ineffective therapies like antibiotics and inhaled salbutamol.
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Affiliation(s)
- Carlotta Biagi
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy; (C.B.); (M.F.); (A.D.); (M.G.); (M.L.); (L.P.)
| | - Sara Scarpini
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
| | - Camilla Paleari
- Specialty School of Pediatrics, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
| | - Marianna Fabi
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy; (C.B.); (M.F.); (A.D.); (M.G.); (M.L.); (L.P.)
| | - Arianna Dondi
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy; (C.B.); (M.F.); (A.D.); (M.G.); (M.L.); (L.P.)
| | - Liliana Gabrielli
- Microbiology Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy;
| | - Monia Gennari
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy; (C.B.); (M.F.); (A.D.); (M.G.); (M.L.); (L.P.)
| | - Marcello Lanari
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy; (C.B.); (M.F.); (A.D.); (M.G.); (M.L.); (L.P.)
| | - Luca Pierantoni
- Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant’Orsola Hospital, 40138 Bologna, Italy; (C.B.); (M.F.); (A.D.); (M.G.); (M.L.); (L.P.)
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Watkins LA, Dial SP, Koenig SJ, Kurepa DN, Mayo PH. The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. J Intensive Care Med 2021; 37:1029-1036. [PMID: 34632837 DOI: 10.1177/08850666211047824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.
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Affiliation(s)
- Laura A Watkins
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 6923Present Affiliation: University of Rochester, Rochester, NY, USA
| | - Sharon P Dial
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Seth J Koenig
- 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dalibor N Kurepa
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paul H Mayo
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 5799Northwell LIJ/NSUH Hospital, New Hyde Park, NY, USA
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Ciuca IM, Dediu M, Marc MS, Lukic M, Horhat DI, Pop LL. Lung Ultrasound Is More Sensitive for Hospitalized Consolidated Pneumonia Diagnosis Compared to CXR in Children. CHILDREN (BASEL, SWITZERLAND) 2021; 8:659. [PMID: 34438550 PMCID: PMC8391397 DOI: 10.3390/children8080659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of death among children; thus, a correct early diagnosis would be ideal. The imagistic diagnosis still uses chest X-ray (CXR), but lung ultrasound (LUS) proves to be reliable for pneumonia diagnosis. The aim of our study was to evaluate the sensitivity and specificity of LUS compared to CXR in consolidated pneumonia. METHODS Children with clinical suspicion of bacterial pneumonia were screened by LUS for pneumonia, followed by CXR. The agreement relation between LUS and CXR regarding the detection of consolidation was evaluated by Cohen's kappa test. RESULTS A total of 128 patients with clinical suspicion of pneumonia were evaluated; 74 of them were confirmed by imagery and biological inflammatory markers. The highest frequency of pneumonia was in the 0-3 years age group (37.83%). Statistical estimation of the agreement between LUS and CXR in detection of the consolidation found an almost perfect agreement, with a Cohen's kappa coefficient of K = 0.89 ± 0.04 SD, p = 0.000. Sensitivity of LUS was superior to CXR in detection of consolidations. CONCLUSION Lung ultrasound is a reliable method for the detection of pneumonia consolidation in hospitalized children, with sensitivity and specificity superior to CXR. LUS should be used for rapid and safe evaluation of child pneumonia.
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Affiliation(s)
- Ioana Mihaiela Ciuca
- Pediatric Department, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (I.M.C.); (M.D.); (L.L.P.)
- Pediatric Pulmonology Unit, Clinical County Hospital, 300226 Timisoara, Romania
| | - Mihaela Dediu
- Pediatric Department, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (I.M.C.); (M.D.); (L.L.P.)
| | - Monica Steluta Marc
- Pediatric Pulmonology Unit, Clinical County Hospital, 300226 Timisoara, Romania
| | - Mirabela Lukic
- Pulmonology Department, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Delia Ioana Horhat
- ENT Department, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania;
| | - Liviu Laurentiu Pop
- Pediatric Department, University of Medicine and Pharmacy “Victor Babes”, 300041 Timisoara, Romania; (I.M.C.); (M.D.); (L.L.P.)
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Boundary Restored Network for Subpleural Pulmonary Lesion Segmentation on Ultrasound Images at Local and Global Scales. J Digit Imaging 2021; 33:1155-1166. [PMID: 32556913 DOI: 10.1007/s10278-020-00356-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To evaluate the application of machine learning for the detection of subpleural pulmonary lesions (SPLs) in ultrasound (US) scans, we propose a novel boundary-restored network (BRN) for automated SPL segmentation to avoid issues associated with manual SPL segmentation (subjectivity, manual segmentation errors, and high time consumption). In total, 1612 ultrasound slices from 255 patients in which SPLs were visually present were exported. The segmentation performance of the neural network based on the Dice similarity coefficient (DSC), Matthews correlation coefficient (MCC), Jaccard similarity metric (Jaccard), Average Symmetric Surface Distance (ASSD), and Maximum symmetric surface distance (MSSD) was assessed. Our dual-stage boundary-restored network (BRN) outperformed existing segmentation methods (U-Net and a fully convolutional network (FCN)) for the segmentation accuracy parameters including DSC (83.45 ± 16.60%), MCC (0.8330 ± 0.1626), Jaccard (0.7391 ± 0.1770), ASSD (5.68 ± 2.70 mm), and MSSD (15.61 ± 6.07 mm). It also outperformed the original BRN in terms of the DSC by almost 5%. Our results suggest that deep learning algorithms aid fully automated SPL segmentation in patients with SPLs. Further improvement of this technology might improve the specificity of lung cancer screening efforts and could lead to new applications of lung US imaging.
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Diagnostic Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:509-527. [PMID: 34215400 DOI: 10.1016/j.emc.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Point-of-care ultrasound has become an essential part of pediatric emergency medicine training and practice. It can have significant clinical benefits, including improving diagnostic accuracy and decreasing length of stay, and does not require radiation exposure for patients. In this review, we summarize the current diagnostic point-of-care ultrasound applications in pediatric emergency medicine, their evidence, and techniques.
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Point of care diaphragm ultrasound: An objective tool to predict the severity of pneumonia and outcomes in children. Pediatr Pulmonol 2021; 56:1666-1672. [PMID: 33656255 DOI: 10.1002/ppul.25352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia. METHODS Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated. RESULTS There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values. CONCLUSION DUS can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Li W, Fu M, Qian C, Liu X, Zeng L, Peng X, Hong Y, Zhou H, Yuan L. Quantitative assessment of COVID-19 pneumonia in neonates using lung ultrasound score. Pediatr Pulmonol 2021; 56:1419-1426. [PMID: 33713586 PMCID: PMC8250904 DOI: 10.1002/ppul.25325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) and lung ultrasound score (LUSS) have been successfully used to diagnose neonatal pneumonia, assess the lesion distribution, and quantify the aeration loss. The present study design determines the diagnostic value of LUSS in the semi-quantitative assessment of pneumonia in coronavirus disease 2019 (COVID-19) neonates. METHODS Eleven COVID-19 neonates born to mothers with COVID-19 infection and 11 age- and gender-matched controls were retrospectively studied. LUSS was acquired by assessing the lesions and aeration loss in 12 lung regions per subject. RESULTS Most of the COVID-19 newborns presented with mild and atypical symptoms, mainly involving respiratory and digestive systems. In the COVID-19 group, a total of 132 regions of the lung were examined, 83 regions (62.8%) of which were detected abnormalities by LUS. Compared with controls, COVID-19 neonates showed sparse or confluent B-lines (83 regions), disappearing A-lines (83 regions), abnormal pleural lines (29 regions), and subpleural consolidations (2 regions). The LUSS was significantly higher in the COVID-19 group. In total, 49 regions (37%) were normal, 73 regions (55%) scored 1, and 10 regions (8%) scored 2 by LUSS. All the lesions were bilateral, with multiple regions involved. The majority of the lesions were located in the bilateral inferior and posterior regions. LUS detected abnormalities in three COVID-19 neonates with normal radiological performance. The intra-observer and inter-observer reproducibility of LUSS was excellent. CONCLUSIONS LUS is a noninvasive, convenient, and sensitive method to assess neonatal COVID-19 pneumonia, and can be used as an alternative to the use of diagnostic radiography. LUSS provides valuable semi-quantitative information on the lesion distribution and severity.
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Affiliation(s)
- Wei Li
- Department of Medical Ultrasonics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Manli Fu
- Department of Medical Ultrasonics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Chao Qian
- Department of Medical Ultrasonics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xin Liu
- Department of Neonatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Lingkong Zeng
- Department of Neonatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xuehua Peng
- Department of Radiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yue Hong
- Department of Medical Ultrasonics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Huan Zhou
- Department of Medical Ultrasonics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Li Yuan
- Department of Medical Ultrasonics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Salisbury T, Redfern A, Fletcher EK, Arkedis J, Bundala F, Connor A, Kapologwe NA, Massaga J, Mkongwa N, Musa B, Lee C. Correct diagnosis of childhood pneumonia in public facilities in Tanzania: a randomised comparison of diagnostic methods. BMJ Open 2021; 11:e042895. [PMID: 34031109 PMCID: PMC8149435 DOI: 10.1136/bmjopen-2020-042895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study compares two methods for clinical diagnosis of childhood pneumonia that aim to estimate rates of underdiagnosis and overdiagnosis of childhood pneumonia by examining the sensitivity of Integrated Management of Childhood Diseases implementation in routine care against lung ultrasound (LUS) diagnosis. SETTING We conducted observations in 83 public health facilities (dispensaries, health centres and district hospitals) in Pwani, Dodoma and Tabora, Tanzania between October and December 2017. METHODS We used a novel method to estimate rates of underdiagnosis and overdiagnosis of childhood pneumonia by comparing directly observed public provider diagnoses to the results of diagnoses made by trained clinicians using Mindray DP-10 ultrasound machines. We perform multivariate analysis to identify confounding effects and robustness checks to bound the result. We also explore a number of observable characteristics correlated with higher rates of agreement between provider diagnoses and ultrasound diagnoses. RESULTS We observed 93 providers conducting exams on patients aged 2 months-5 years who presented respiratory symptoms or were given a respiratory diagnosis by the provider. Of these 957 patients, 110 were excluded from analysis resulting in a final sample of 847.17.6% of cases identified as pneumonia via LUS examinations in our sample were diagnosed as pneumonia by providers, suggesting that a significant number of pneumonia cases for which care is sought in the public sector go undiagnosed. Provider knowledge of breath counting and years of experience are positively correlated with higher agreement. While clinical examination rates are not statistically correlated with agreement, it is notable that providers conducted a clinical examination on only about one-third of patients in the sample. CONCLUSION Our results suggest that provider training and knowledge of clinical examination protocols for pneumonia diagnosis are predictive of correct diagnosis of pneumonia and should be further explored in future research as a tool for improving quality of care.
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Affiliation(s)
| | | | | | - Jean Arkedis
- Results for Development Institute, Washington, DC, USA
| | - Felix Bundala
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | | | - Ntuli A Kapologwe
- Social Welfare and Nutrition Services, President's Office Regional Administration and Local Government, Dodoma, Tanzania
| | - Julius Massaga
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Naibu Mkongwa
- Reproductive and Child Health Section, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Balowa Musa
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Dar es Salaam, Tanzania
| | - Cammie Lee
- Results for Development Institute, Washington, DC, USA
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Deana C, Rovida S, Orso D, Bove T, Bassi F, De Monte A, Vetrugno L. Learning from the Italian experience during COVID-19 pandemic waves: be prepared and mind some crucial aspects. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021097. [PMID: 33988143 PMCID: PMC8182622 DOI: 10.23750/abm.v92i2.11159] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic has rapidly spread worldwide causing a serious challenge to the global medical community. Italy was struck hard during the first wave earlier this year and several weaknesses as well as general unpreparedness of the national healthcare system were acknowledged. Learning essential lessons from the past, we realized how implementing contingency response measures, human resources and social dynamics could have changed the outcome if promptly adopted. This review translates the previous experience into strategic actions that has to be considered when developing appropriate national and regional operational plans to respond to a pandemic.
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Affiliation(s)
| | - Serena Rovida
- 2Department of Anesthesia and Intensive Care Unit, Saint Bartholomew's Hospital, Barts NHS Trust, London, UK..
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy..
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy..
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Amato De Monte
- Department of Anesthesia and Intensive Care, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy..
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Hizal M, Aykac K, Yayla BCC, Yilmaz A, Altun D, Akkaya HE, Bayhan GI, Kurt ANC, Karakaya J, Ozsurekci Y, Ceyhan M. Diagnostic value of lung ultrasonography in children with COVID-19. Pediatr Pulmonol 2021; 56:1018-1025. [PMID: 33085218 DOI: 10.1002/ppul.25127] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with novel coronavirus disease 2019 (COVID-19). METHODS AND OBJECTIVES Prospective multicenter study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X-ray and computed tomography (CT) were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT findings and diagnostic performance was determined. RESULTS Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 of 16 patients who had normal CT features. The sensitivity and the area under the receiver operating characteristics (ROC) curve (area under the ROC curve) identified by the chest X-ray and LUS tests were compared and statistically significantly different (McNemar's test: p = .016 and p = .001 respectively) detected. Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. CONCLUSIONS LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children.
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Affiliation(s)
- Mina Hizal
- Department of Pediatric Pulmonology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | | | - Burcu C C Yayla
- Department of Pediatric Infectious Disease, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Arzu Yilmaz
- Department of Pediatric, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Demet Altun
- Department of Pediatrics, Faculty of Medicine, Ufuk University, Ankara, Turkey
| | - Habip E Akkaya
- Department of Radiology, Ankara Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Gulsum I Bayhan
- Department of Pediatric Infectious Disease, Yenimahalle Training and Educational Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Aysegul N C Kurt
- Department of Pediatrics, Yenimahalle Training and Educational Hospital, Yildirim Beyazit University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Disease, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Poly TN, Islam MM, Li YCJ, Alsinglawi B, Hsu MH, Jian WS, Yang HC. Application of Artificial Intelligence for Screening COVID-19 Patients Using Digital Images: Meta-analysis. JMIR Med Inform 2021; 9:e21394. [PMID: 33764884 PMCID: PMC8086786 DOI: 10.2196/21394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/04/2020] [Accepted: 03/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The COVID-19 outbreak has spread rapidly and hospitals are overwhelmed with COVID-19 patients. While analysis of nasal and throat swabs from patients is the main way to detect COVID-19, analyzing chest images could offer an alternative method to hospitals, where health care personnel and testing kits are scarce. Deep learning (DL), in particular, has shown impressive levels of performance when analyzing medical images, including those related to COVID-19 pneumonia. OBJECTIVE The goal of this study was to perform a systematic review with a meta-analysis of relevant studies to quantify the performance of DL algorithms in the automatic stratification of COVID-19 patients using chest images. METHODS A search strategy for use in PubMed, Scopus, Google Scholar, and Web of Science was developed, where we searched for articles published between January 1 and April 25, 2020. We used the key terms "COVID-19," or "coronavirus," or "SARS-CoV-2," or "novel corona," or "2019-ncov," and "deep learning," or "artificial intelligence," or "automatic detection." Two authors independently extracted data on study characteristics, methods, risk of bias, and outcomes. Any disagreement between them was resolved by consensus. RESULTS A total of 16 studies were included in the meta-analysis, which included 5896 chest images from COVID-19 patients. The pooled sensitivity and specificity of the DL models in detecting COVID-19 were 0.95 (95% CI 0.94-0.95) and 0.96 (95% CI 0.96-0.97), respectively, with an area under the receiver operating characteristic curve of 0.98. The positive likelihood, negative likelihood, and diagnostic odds ratio were 19.02 (95% CI 12.83-28.19), 0.06 (95% CI 0.04-0.10), and 368.07 (95% CI 162.30-834.75), respectively. The pooled sensitivity and specificity for distinguishing other types of pneumonia from COVID-19 were 0.93 (95% CI 0.92-0.94) and 0.95 (95% CI 0.94-0.95), respectively. The performance of radiologists in detecting COVID-19 was lower than that of the DL models; however, the performance of junior radiologists was improved when they used DL-based prediction tools. CONCLUSIONS Our study findings show that DL models have immense potential in accurately stratifying COVID-19 patients and in correctly differentiating them from patients with other types of pneumonia and normal patients. Implementation of DL-based tools can assist radiologists in correctly and quickly detecting COVID-19 and, consequently, in combating the COVID-19 pandemic.
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Affiliation(s)
- Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei, Taiwan
| | - Belal Alsinglawi
- School of Computer, Data, and Mathematical Science, Western Sydney University, Sydney, Australia
| | - Min-Huei Hsu
- Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan
| | - Wen Shan Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Ferrero P, Piazza I. Cardio-thoracic imaging and COVID-19 in the pediatric population: A narrative review. World J Radiol 2021; 13:94-101. [PMID: 33968312 PMCID: PMC8069348 DOI: 10.4329/wjr.v13.i4.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 04/14/2021] [Indexed: 02/06/2023] Open
Abstract
Worldwide experience about coronavirus disease 2019 (COVID-19) pandemics suggests that symptomatic disease is significantly less frequent in the pediatric age range. Nevertheless, multi-system inflammatory syndrome has been consistently reported in children and has been associated with severe acute respiratory syndrome coronavirus 2 exposure. In this paper we give an overview of the multimodality chest imaging of pediatric patients with suspected COVID-19, focusing on relevant differences with adults.
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Affiliation(s)
- Paolo Ferrero
- ACHD Unit–Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese 20097, Milan, Italy
| | - Isabelle Piazza
- Department of Emergency Medicine, ASST Papa Giovanni XXIII, Bergamo 24127, Italy
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Liu J, Lovrenski J, Ye Hlaing A, Kurepa D. Neonatal lung diseases: lung ultrasound or chest x-ray. J Matern Fetal Neonatal Med 2021; 34:1177-1182. [PMID: 31220971 DOI: 10.1080/14767058.2019.1623198] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chest X-ray (CXR) examination is a well-recognized imaging modality in the diagnosis of neonatal lung diseases. On the other hand, lung ultrasound (LUS) has been an emerging and increasingly studied modality. However, the role of LUS as well as its potential to replace CXRs in the detection of neonatal lung diseases has been debated. We combine the present research progress and our own clinical experience to elaborate on various aspects of the potential routine use of lung ultrasound in neonatal intensive care units. We conclude that both LUS and CXR have a number of advantages and disadvantages. They should serve as complementary diagnostic methods in providing accurate, timely, and reliable information.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Arkar Ye Hlaing
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New York, NY, USA
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New York, NY, USA
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47
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Pietersen PI, Klap B, Hersch N, Laursen CB, Walsh S, Annema J, Gompelmann D. ERS International Congress 2020: highlights from the Clinical Techniques, Imaging and Endoscopy assembly. ERJ Open Res 2021; 7:00118-2021. [PMID: 34084779 PMCID: PMC8165368 DOI: 10.1183/23120541.00118-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 12/15/2022] Open
Abstract
The European Respiratory Society congress in the year 2020, a year dominated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, was the first virtual congress planned with an innovative and interactive congress programme upfront. It was a large, novel platform for scientific discussion and presentations of cutting-edge innovative developments. This article summarises a selection of the scientific highlights from the Clinical Techniques, Imaging and Endoscopy assembly (assembly 14). In addition to presentations on the important role of bronchoscopy, imaging and ultrasound techniques in the field of SARS-CoV-2 infection, novel diagnostic approaches and innovative therapeutic strategies in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases were discussed.
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Affiliation(s)
- Pia Iben Pietersen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Regional Center for Technical Simulation, Region of Southern Denmark, Odense, Denmark
| | - Bibi Klap
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole Hersch
- Dept of Respiratory Medicine, St George Hospital, Sydney, Australia
| | - Christian B. Laursen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Dept of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Simon Walsh
- National Heart and Lung Institute, Imperial College, London, UK
| | - Jouke Annema
- Dept of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Gompelmann
- Dept of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria
- Division of Thoracic Surgery, Medial University of Vienna, Vienna, Austria
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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Yu LF, Xu CK, Zhao M, Niu L, Huang XM, Zhang ZQ. Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus. World J Clin Cases 2021; 9:1827-1834. [PMID: 33748231 PMCID: PMC7953406 DOI: 10.12998/wjcc.v9.i8.1827] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patent ductus arteriosus (PDA) is a common congenital heart abnormality in preterm neonates with a high incidence in neonates with very low birth weights. When PDA persists, interstitial lung water content increases, which could lead to abnormal circulation hemodynamics and pulmonary edema. It is important to perform early and reliable assessment of lung water content in very low-weight preterm neonates with persistent PDA. AIM To evaluate the role of bedside cardiopulmonary ultrasonography in the lung water content assessment in very low-weight preterm neonates with persistent PDA. METHODS From January 2018 to March 2020, 69 very low-weight preterm neonates with echocardiography-confirmed PDA were selected as the PDA group. At the same time, 89 very low-weight preterm neonates without PDA were randomly selected as the control group. All neonates underwent echocardiography and 6-segment lung ultrasonography on the fourth day after birth. The clinical characteristics and main ultrasonography results were compared between the two groups. Pearson's analysis was used to analyze the correlation between lung ultrasonography score (LUS) and other related clinical and ultrasonography results in all neonates. In the PDA group, PDA diameters were recorded, and the correlation with LUS and left atrium to aortic (LA/AO) dimension ratio were also analyzed. LA/AO ratio is one of the ultrasonic diagnostic criteria for hemodynamically significant PDA. When the ratio is ≥ 1.5, it suggests the possibility of hemodynamic changes in persistent PDA. A receiver operating characteristic curve was established using the sensitivity of LUS to predict the hemodynamic changes in neonates with PDA as the ordinate and 1-specificity as the abscissa. RESULTS A total of 158 neonates were enrolled in this study, including 69 in the PDA group and 89 in the control group. There were no statistical differences in sex, gestational age, birth weight, ventilator dependence, hospitalization length and left ventricular ejection fraction between the two groups (P > 0.05). The LUS and LA/AO ratio in the PDA group were higher than those in the control group (P < 0.05), but there was no difference of LUS in neonates with or without use of the ventilator (t = 0.58, P = 0.16). In all cases, LUS was negatively correlated with gestational age (r = -0.28, P < 0.01) and birth weight (r = -0.36, P < 0.01), while positively correlated with the LA/AO ratio (r = 0.27, P < 0.01). In the PDA group, PDA diameter was positively correlated with the LA/AO ratio (r = 0.39, P < 0.01) and LUS (r = 0.31, P < 0.01). Receiver operating characteristic results showed that LUS had the moderate accuracy for predicting hemodynamic changes in PDA (area under the curve = 0.741; sensitivity = 93.75%; specificity = 50.94%). CONCLUSION Bedside cardiopulmonary ultrasonography can evaluate lung content in neonates with PDA and predict the possibility of hemodynamic changes in persistent PDA.
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Affiliation(s)
- Li-Fang Yu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Chen-Ke Xu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Min Zhao
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Lin Niu
- Department of Ultrasound, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Xian-Mei Huang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
| | - Zhi-Qun Zhang
- Department of Pediatrics, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
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Riaz A, Cambaco O, Ellington LE, Lenahan JL, Munguambe K, Mehmood U, Lamorte A, Qaisar S, Baloch B, Kanth N, Nisar MI, Volpicelli G, Bassat Q, Jehan F, Ginsburg AS. Feasibility, usability and acceptability of paediatric lung ultrasound among healthcare providers and caregivers for the diagnosis of childhood pneumonia in resource-constrained settings: a qualitative study. BMJ Open 2021; 11:e042547. [PMID: 33707268 PMCID: PMC7957133 DOI: 10.1136/bmjopen-2020-042547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Paediatric pneumonia burden and mortality are highest in low-income and middle-income countries (LMIC). Paediatric lung ultrasound (LUS) has emerged as a promising diagnostic tool for pneumonia in LMIC. Despite a growing evidence base for LUS use in paediatric pneumonia diagnosis, little is known about its potential for successful implementation in LMIC. Our objectives were to evaluate the feasibility, usability and acceptability of LUS in the diagnosis of paediatric pneumonia. DESIGN Prospective qualitative study using semistructured interviews SETTING: Two referral hospitals in Mozambique and Pakistan PARTICIPANTS: A total of 21 healthcare providers (HCPs) and 20 caregivers were enrolled. RESULTS HCPs highlighted themes of limited resource availability for the feasibility of LUS implementation, including perceived high cost of equipment, maintenance demands, time constraints and limited trained staff. HCPs emphasised the importance of policymaker support and caregiver acceptance for long-term success. HCP perspectives of usability highlighted ease of use and integration into existing workflow. HCPs and caregivers had positive attitudes towards LUS with few exceptions. Both HCPs and caregivers emphasised the potential for rapid, improved diagnosis of paediatric respiratory conditions using LUS. CONCLUSIONS This was the first study to evaluate HCP and caregiver perspectives of paediatric LUS through qualitative analysis. Critical components impacting feasibility, usability and acceptability of LUS for paediatric pneumonia diagnosis in LMIC were identified for initial deployment. Future research should explore LUS sustainability, with a particular focus on quality control, device maintenance and functionality and adoption of the new technology within the health system. This study highlights the need to engage both users and recipients of new technology early in order to adapt future interventions to the local context for successful implementation. TRIAL REGISTRATION NUMBER NCT03187067.
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Affiliation(s)
- Atif Riaz
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Olga Cambaco
- Centro de Investigação em Saúde de Manhiça, Manhica, Maputo, Mozambique
| | | | | | - Khatia Munguambe
- Centro de Investigacao em Saude de Manhica, Manhica, Maputo, Mozambique
| | - Usma Mehmood
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Alessandro Lamorte
- Emergency Medicine, Umberto Parini Hospital, Aosta, Valle d'Aosta, Italy
| | - Sana Qaisar
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Neel Kanth
- Children's Hospital-Poverty Eradication Initiative, Sindh Government Hospital Karachi, Karachi, Sindh, Pakistan
| | | | | | - Quique Bassat
- ISGLOBAL, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Fyezah Jehan
- Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Amy Sarah Ginsburg
- Clinical Trial Center, University of Washington, Seattle, Washington, USA
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