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Kessler D, Zhu M, Gregory CR, Mehanian C, Avila J, Avitable N, Coneybeare D, Das D, Dessie A, Kennedy TM, Rabiner J, Malia L, Ng L, Nye M, Vindas M, Weimersheimer P, Kulhare S, Millin R, Gregory K, Zheng X, Horning MP, Stone M, Wang F, Lancioni C. Development and testing of a deep learning algorithm to detect lung consolidation among children with pneumonia using hand-held ultrasound. PLoS One 2024; 19:e0309109. [PMID: 39190686 DOI: 10.1371/journal.pone.0309109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Severe pneumonia is the leading cause of death among young children worldwide, disproportionately impacting children who lack access to advanced diagnostic imaging. Here our objectives were to develop and test the accuracy of an artificial intelligence algorithm for detecting features of pulmonary consolidation on point-of-care lung ultrasounds among hospitalized children. METHODS This was a prospective, multicenter center study conducted at academic Emergency Department and Pediatric inpatient or intensive care units between 2018-2020. Pediatric participants from 18 months to 17 years old with suspicion of lower respiratory tract infection were enrolled. Bedside lung ultrasounds were performed using a Philips handheld Lumify C5-2 transducer and standardized protocol to collect video loops from twelve lung zones, and lung features at both the video and frame levels annotated. Data from both affected and unaffected lung fields were split at the participant level into training, tuning, and holdout sets used to train, tune hyperparameters, and test an algorithm for detection of consolidation features. Data collected from adults with lower respiratory tract disease were added to enrich the training set. Algorithm performance at the video level to detect consolidation on lung ultrasound was determined using reference standard diagnosis of positive or negative pneumonia derived from clinical data. RESULTS Data from 107 pediatric participants yielded 117 unique exams and contributed 604 positive and 589 negative videos for consolidation that were utilized for the algorithm development process. Overall accuracy for the model for identification and localization of consolidation was 88.5%, with sensitivity 88%, specificity 89%, positive predictive value 89%, and negative predictive value 87%. CONCLUSIONS Our algorithm demonstrated high accuracy for identification of consolidation features on pediatric chest ultrasound in children with pneumonia. Automated diagnostic support on an ultraportable point-of-care device has important implications for global health, particularly in austere settings.
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Affiliation(s)
- David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Meihua Zhu
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - Cynthia R Gregory
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - Courosh Mehanian
- Oregon Health & Science University, Portland, Oregon, United States of America
- University of Oregon, Eugene, OR, United States of America
- Global Health Labs Inc, Bellevue, WA, United States of America
| | - Jailyn Avila
- University of Kentucky, Lexington, KY, United States of America
| | - Nick Avitable
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Di Coneybeare
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Devjani Das
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Thomas M Kennedy
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Joni Rabiner
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Laurie Malia
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Lorraine Ng
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Megan Nye
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Marc Vindas
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, NY, NY, United States of America
| | - Peter Weimersheimer
- University of Vermont Larner College of Medicine, Burlington, VT, United States of America
| | - Sourabh Kulhare
- Global Health Labs Inc, Bellevue, WA, United States of America
| | - Rachel Millin
- Global Health Labs Inc, Bellevue, WA, United States of America
| | - Kenton Gregory
- Oregon Health & Science University, Portland, Oregon, United States of America
| | - Xinliang Zheng
- Global Health Labs Inc, Bellevue, WA, United States of America
| | | | - Mike Stone
- Legacy Emanuel Medical Center, Portland, OR, United States of America
| | - Fen Wang
- Oregon Health & Science University, Portland, Oregon, United States of America
- Fudan University, Shanghai, China
| | - Christina Lancioni
- Oregon Health & Science University, Portland, Oregon, United States of America
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Xie W, Ruan J, Jiang Q, Zheng J, Lin W, Lyu G. Distinguishing types and severity of pediatric pneumonia using modified lung ultrasound score. Front Pediatr 2024; 12:1411365. [PMID: 39161635 PMCID: PMC11330795 DOI: 10.3389/fped.2024.1411365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/24/2024] [Indexed: 08/21/2024] Open
Abstract
Objective This study aimed to investigate the diagnostic utility of the modified lung ultrasound score (MLUS) in distinguishing between Mycoplasma pneumonia and viral pneumonia in children and evaluate their severity. Methods A prospective collection of 137 suspected cases of community-acquired pneumonia in children admitted to the Quanzhou Maternity and Children's Hospital in Quanzhou City, Fujian Province, from January 2023 to December 2023 constituted the study cohort. All patients underwent lung ultrasound examinations, and MLUS scores were assigned based on ultrasound findings, including pleural lines, A-lines, B-lines, and lung consolidations. Based on the pathogenic results, the patients were categorized into the Mycoplasma pneumonia (74 cases) and viral pneumonia (63 cases) groups. The severity was classified as mild (110 cases) or severe (27 cases). The diagnostic value of MLUS for Mycoplasma pneumonia and viral pneumonia in children was analyzed. Results (1) MLUS scores were significantly different between the Mycoplasma pneumonia (15, 10-21) and viral pneumonia (8, 5-16) groups (P = 0.002). ROC curve analysis indicated that using a cut-off value of 11, MLUS exhibited a sensitivity of 70.3%, specificity of 58.7%, and an area under curve (AUC) of 0.653 for diagnosing Mycoplasma pneumonia. Furthermore, large-area lung consolidation on ultrasound images demonstrated good diagnostic performance for predicting Mycoplasma pneumonia, with an AUC of 0.763, a sensitivity of 71.6%, and a specificity of 81.0%. (2) MLUS scores were significantly different between the mild pneumonia (10.5, 5-17) and severe pneumonia (21, 16-29) groups (P < 0.001). ROC curve analysis using a cut-off value of 16 showed a sensitivity of 77.8%, specificity of 73.6%, and AUC of 0.818 for diagnosing severe pneumonia. Multivariate regression analysis revealed that both MLUS and white blood cell count were independent factors influencing the severity. The constructed nomogram model demonstrated robust stability with a sensitivity of 85.2%, a specificity of 74.5%, and an AUC of 0.858 for predicting severe childhood pneumonia. Conclusion MLUS, coupled with ultrasound signs of large-area lung consolidation, had reference significance for the differential diagnosis of Mycoplasma pneumonia and viral pneumonia in children and can be a preliminary assessment of the severity of viral pneumonia or mycoplasma pneumonia in children.
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Affiliation(s)
- Wen Xie
- Department of Ultrasound, Quanzhou Maternity and Children’s Hospital, Quanzhou, China
| | - Junxian Ruan
- Department of Ultrasound, Quanzhou Maternity and Children’s Hospital, Quanzhou, China
| | - Qiuxia Jiang
- Department of Ultrasound, Quanzhou Maternity and Children’s Hospital, Quanzhou, China
| | - Jingyang Zheng
- Department of Pneumology, Quanzhou Maternity and Children’s Hospital, Quanzhou, China
| | - Weiru Lin
- Department of Ultrasound, Quanzhou Maternity and Children’s Hospital, Quanzhou, China
| | - Guorong Lyu
- The Headmaster's Office, Quanzhou Medical College, Quanzhou, China
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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Supino MC, Buonsenso D, Agostiniani R, Gori L, Tipo V, Morello R, Del Monaco G, Falsaperla R, Biagi C, Cazzato S, Villani A, Musolino AM. The lung ultrasound in children with SARS-COV-2 infection: a national multicenter prospective study. Eur J Pediatr 2024; 183:3397-3405. [PMID: 38767693 DOI: 10.1007/s00431-024-05609-0] [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: 02/23/2024] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
Coronavirus disease-19 (COVID-19) caused hospitalizations, severe disease, and deaths in any age, including in the youngest children. The aim of this multicenter national study is to characterize the clinical and the prognostic role of lung ultrasound (LU) in children with COVID-19. We enrolled children between 1 month and 18 years of age with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who underwent a LU within 6 h from the first medical evaluation. A total of 213 children were enrolled, 51.6% were male, median age was 2 years and 5 months (interquartile range (IQR) 4 months -11 years and 4 months). One hundred and forty-eight (69.4%) children were admitted in hospital, 9 (6.1%) in pediatric intensive care unit. We found an inverse correlation between the lung ultrasound score (LUS) and the oxygen saturation at the first clinical evaluation (r = -0.16; p = 0.019). Moreover, LUS was significantly higher in patients requiring oxygen supplementation (8 (IQR 3-19) vs 2 (IQR 0-4); p = 0.001). Among LU pathological findings, irregular pleural lines, subpleural consolidations, and pleural effusions were significantly more frequent in patients needing oxygen supplementation (p = 0.007, p = 0.006, and p = 0.001, respectively). Conclusion: This multicenter study showed that LU in children with COVID-19 can highlight pleural line irregularities, vertical artifacts, and subpleural consolidation. Notably, children with higher LUS have a higher risk of hospitalization and need for oxygen supplementation, supporting LU as a valid and safe point-of-care first level tool for the clinical evaluation of children with COVID-19. What is Known: • Few children infected with SARS-CoV-2 develop a severe disease and need oxygen therapy. • Lung ultrasound can easily detect low respiratory tract infection during SARS-CoV-2. What is New: • Children with higher lung ultrasound score have a higher risk of need for oxygen supplementation. • Irregular pleural line, sub-pleural consolidations and pleural effusions were significantly more frequent in patients needing oxygen supplementation.
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Affiliation(s)
- Maria Chiara Supino
- Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Laura Gori
- Department of Maternal and Child Health, Division of Pediatric Unit, S. Chiara Hospital, Pisa, Italy
| | - Vincenzo Tipo
- Pediatric Emergency and Short Stay Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Falsaperla
- Neonatal Intensive Care Unit [NICU], AOU "Rodolico-San Marco", PO "San Marco", University of Catania, Catania, Italy
| | - Carlotta Biagi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Cazzato
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Alberto Villani
- Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Maria Musolino
- Pediatric Emergency Unit, Pediatric Emergency Department and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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4
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Liu J. Lung Ultrasonography Cannot Identify the Etiology of Pediatric Pneumonia. Arch Bronconeumol 2024; 60:445-447. [PMID: 38490926 DOI: 10.1016/j.arbres.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital Affiliated with Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China.
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Gao J, Wu R, Zhang YJ, Xu X, Sa RN, Li XA, Liu CY. Quantitative evaluation of bronchoalveolar lavage for the treatment of severe Mycoplasma pneumoniae pneumonia in children-A new complementary index: Bronchial Insufflation Sign Score. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:667-674. [PMID: 38581196 DOI: 10.1002/jcu.23678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the value of Broncoplasma Insufflation Sign in lung ultrasound signs in assessing the efficacy of bronchoalveolar lavage in severe Mycoplasma pneumoniae pneumonia in children. METHODS Forty-seven children with severe Mycoplasma pneumoniae pneumonia were treated with medication and bronchial lavage. Laboratory and imaging results were collected, and lung ultrasonography was performed before bronchoalveolar lavage and 1, 3, and 7 days after lavage to record changes in Bronchial Insufflation Sign and changes in the extent of solid lung lesions. Factors affecting the effectiveness of bronchoalveolar lavage were analyzed using logistic regression and other factors. RESULTS Bronchial Insufflation Sign Score and the extent of lung solid lesions were the factors affecting the effectiveness of bronchoalveolar lavage treatment. The smaller the area of lung solid lesions and the higher the Bronchial Insufflation Sign Score, the more effective the results of bronchoalveolar lavage treatment were, and the difference was statistically significant, with a difference of p < 0.05. The Bronchial Insufflation Sign Score had the highest sensitivity and specificity for the prediction of the efficacy of bronchoalveolar lavage treatment in the first 7 days after the treatment. CONCLUSION Bronchial Insufflation Sign Score combined with the extent of solid lung lesions can assess the efficacy of bronchoalveolar lavage in the treatment of severe Mycoplasma pneumoniae pneumonia in children; lung ultrasound is a timely and effective means of assessing the efficacy of bronchoalveolar lavage.
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Affiliation(s)
- Jin Gao
- Baotou Medical College, Baotou, China
| | - R Wu
- Ordos Central Hospital, Ordos, China
| | - Y J Zhang
- Ordos Central Hospital, Ordos, China
| | - X Xu
- Ordos Central Hospital, Ordos, China
| | - R N Sa
- Ordos Central Hospital, Ordos, China
| | - X A Li
- Ordos Central Hospital, Ordos, China
| | - C Y Liu
- Baotou Medical College, Baotou, China
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Becerra-Hervás J, Guitart C, Covas A, Bobillo-Pérez S, Rodríguez-Fanjul J, Carrasco-Jordan JL, Cambra Lasaosa FJ, Jordan I, Balaguer M. The Clinical Pulmonary Infection Score Combined with Procalcitonin and Lung Ultrasound (CPIS-PLUS), a Good Tool for Ventilator Associated Pneumonia Early Diagnosis in Pediatrics. CHILDREN (BASEL, SWITZERLAND) 2024; 11:592. [PMID: 38790587 PMCID: PMC11120099 DOI: 10.3390/children11050592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
Ventilator-associated pneumonia (VAP) is common in Pediatric Intensive Care Units. Although early detection is crucial, current diagnostic methods are not definitive. This study aimed to identify lung ultrasound (LUS) findings and procalcitonin (PCT) values in pediatric patients with VAP to create a new early diagnosis score combined with the Clinical Pulmonary Infection Score (CPIS), the CPIS-PLUS score. Prospective longitudinal and interventional study. Pediatric patients with suspected VAP were included and classified into VAP or non-VAP groups, based on Centers of Disease Control (CDC) criteria for the final diagnosis. A chest-X-ray (CXR), LUS, and blood test were performed within the first 12 h of admission. CPIS score was calculated. A total of 108 patients with VAP suspicion were included, and VAP was finally diagnosed in 51 (47%) patients. CPIS-PLUS showed high accuracy in VAP diagnosis with a sensitivity (Sn) of 80% (95% CI 65-89%) and specificity (Sp) of 73% (95% CI 54-86%). The area under the curve (AUC) resulted in 0.86 for CPIS-PLUS vs. 0.61 for CPIS. In conclusion, this pilot study showed that CPIS-PLUS could be a potential and reliable tool for VAP early diagnosis in pediatric patients. Internal and external validations are needed to confirm the potential value of this score to facilitate VAP diagnosis in pediatric patients.
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Affiliation(s)
- Judit Becerra-Hervás
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain; (J.B.-H.); (C.G.); (S.B.-P.); (F.J.C.L.); (M.B.)
- Faculty of Medicine, University of Barcelona, c. Casanova, 143, 08036 Barcelona, Spain;
| | - Carmina Guitart
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain; (J.B.-H.); (C.G.); (S.B.-P.); (F.J.C.L.); (M.B.)
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
| | - Aina Covas
- Neonatal Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain;
| | - Sara Bobillo-Pérez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain; (J.B.-H.); (C.G.); (S.B.-P.); (F.J.C.L.); (M.B.)
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit, Department of Paediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, 08916 Badalona, Spain;
| | - Josep L. Carrasco-Jordan
- Faculty of Medicine, University of Barcelona, c. Casanova, 143, 08036 Barcelona, Spain;
- Biostatistics, Department of Basic Clinical Practice, University of Barcelona, 08036 Barcelona, Spain
| | - Francisco José Cambra Lasaosa
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain; (J.B.-H.); (C.G.); (S.B.-P.); (F.J.C.L.); (M.B.)
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain; (J.B.-H.); (C.G.); (S.B.-P.); (F.J.C.L.); (M.B.)
- Faculty of Medicine, University of Barcelona, c. Casanova, 143, 08036 Barcelona, Spain;
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
- Pediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, CIBERESP, 08950 Barcelona, Spain
| | - Mònica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain; (J.B.-H.); (C.G.); (S.B.-P.); (F.J.C.L.); (M.B.)
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
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7
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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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8
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Stoicescu ER, Iacob R, Ilie AC, Iacob ER, Susa SR, Ghenciu LA, Constantinescu A, Cocolea DM, Oancea C, Manolescu DL. Differentiating Viral from Bacterial Pneumonia in Children: The Diagnostic Role of Lung Ultrasound-A Prospective Observational Study. Diagnostics (Basel) 2024; 14:480. [PMID: 38472952 DOI: 10.3390/diagnostics14050480] [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: 01/26/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
This prospective observational study aimed to investigate the utility of lung ultrasound (LUS) in diagnosing and managing pediatric respiratory infections, specifically focusing on viral, bacterial, and SARS-CoV-2 infections. Conducted over a period of 1 year and 8 months, this research involved 85 pediatric patients (showcasing a median age of 14 months) recruited based on specific criteria, including age, confirmed infection through multiplex PCR tests, and willingness to undergo LUS imaging. This study employed a 12-area scoring system for LUS examinations, utilizing the lung ultrasound score (LUSS) to evaluate lung abnormalities. The PCR examination results reveal diverse respiratory pathogens, with SARS-CoV-2, influenza, and bacterial co-infections being prominent among the cases. As an observational study, this study was not registered in the registry. Distinct LUS patterns associated with different pathogens were identified, showcasing the discriminatory potential of LUS in differentiating between viral and bacterial etiologies. Bacterial infections demonstrated more severe lung involvement, evident in significantly higher LUSS values compared with viral cases (p < 0.0001). The specific abnormalities found in bacterial superinfection can be integrated into diagnostic and management protocols for pediatric respiratory infections. Overall, this research contributes valuable insights into optimizing LUS as a diagnostic tool in pediatric pneumonia, facilitating more informed and tailored healthcare decisions.
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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
- Research Center for Pharmaco-Toxicological Evaluations, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, Faculty of Mechanics, 'Politehnica' University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
| | - Roxana Iacob
- Field of Applied Engineering Sciences, Specialization Statistical Methods and Techniques in Health and Clinical Research, Faculty of Mechanics, 'Politehnica' University Timisoara, Mihai Viteazul Boulevard No. 1, 300222 Timisoara, Romania
- Department of Anatomy and Embriology, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Adrian Cosmin Ilie
- Department III Functional Sciences, Division of Public Health and Management, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emil Radu Iacob
- Department of Pediatric Surgery, 'Victor Babes' University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Septimiu Radu Susa
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Laura Andreea Ghenciu
- Department of Functional Sciences, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Amalia Constantinescu
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Daiana Marina Cocolea
- Ph.D. School, 'Victor Babes' University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pulmonology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - 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
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), 'Victor Babeș' University of Medicine and Pharmacy, 300041 Timișoara, Romania
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9
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Buz Yaşar A, Tarhan M, Atalay B, Kabaalioğlu A, Girit S. Investigation of Childhood Pneumonia With Thoracic Ultrasound: A Comparison Between X-ray and Ultrasound. Ultrasound Q 2023; 39:216-222. [PMID: 37543750 DOI: 10.1097/ruq.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
ABSTRACT Childhood pneumonia is a common entity, and chest x-rays are widely used as an initial diagnostic step. To avoid radiation exposure in the pediatric age group, we assessed whether the diagnostic accuracy of ultrasound (US) imaging is sufficient in the diagnosis. One hundred thirty-three children with pneumonia (72 girls/61 boys) were participated to study between 2019 and 2021. All participants had a chest x-ray. Radiologists who perform the US scans and interpret the x-rays were blinded to each other. A comparative analysis was also done to assess US findings on pneumonia for different age groups. We compare the diagnostic accuracy of US and x-rays by McNemar test and receiver operating characteristic curves. Intraclass correlation coefficient values were calculated for the assessment of interobserver agreement of x-ray evaluation. The participants' ages ranged from 1 month to 17 years and 8 months with a median age of 24 months (Q 1 : 8 and Q 3 : 66 months). Hospital stay lengths were longer, consolidation depths were greater, and presence of air bronchogram or pleural effusion was more frequent in school-age children. The proportion of consolidation seen on chest x-ray and transthoracic US scan was significantly different ( P < 0.001). The area under the curve was greater in the US than in the chest x-ray (area under the curve, 0.94 and 0.76 respectively). There was a good agreement between the 2 interpreters on chest x-ray assessment ( κ = 0.661). The thoracic US can be used as a safe and efficient imaging tool in the diagnosis of pediatric pneumonia.
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Affiliation(s)
| | - Merve Tarhan
- Department of Radiology, Derince Research and Training Hospital, Kocaeli
| | - Basak Atalay
- Department of Radiology, Faculty of Medicine, Istanbul Medeniyet University
| | | | - Saniye Girit
- Department of Pediatric Pulmonology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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10
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Ling Y, Yang D, Yang S. Clinical characteristics, early blood biochemical indicators, and prognostic status of children with bronchopneumonia. Medicine (Baltimore) 2023; 102:e36162. [PMID: 38013276 PMCID: PMC10681375 DOI: 10.1097/md.0000000000036162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Abstract
To investigate the clinical characteristics, early blood biochemical indicators, and prognostic status of children with bronchopneumonia. We conducted a retrospective analysis of data from 500 children diagnosed with bronchopneumonia at our hospital from June 2019 to December 2022. Based on the severity of the disease, patients were assigned to the severe group (n = 180) or mild group (n = 320), and an additional 150 healthy children were chosen as the control group. Blood indicators [aspartate aminotransferase (AST), plasma carbon dioxide combining power (CO2CP), serum potassium (K+), serum sodium (Na+)], inflammatory markers [interleukin-17 (IL-17), interleukin-10 (IL-10), C-reactive protein (CRP), procalcitonin (PCT)], and cardiac enzyme profiles [lactate dehydrogenase (LDH), creatine kinase (CK), alpha-hydroxybutyrate dehydrogenase (α-HBDH), creatine kinase isoenzyme (CK-MB)] were compared among the 3 groups. The severe group showed more signs such as diarrhea, pleural effusion, and respiratory distress than the mild group. AST levels in the severe group were significantly higher than those in the mild group and control group, while CO2CP, K+, and Na+ were lower than those in the mild group and control group. AST levels in the mild group were significantly higher than those in the control group, while CO2CP and Na + were significantly higher than those in the control group (P < .05). IL-10, IL-17, PCT, and CRP levels in the severe group were higher than those in the mild group and control group, while those in the mild group were higher than those in the control group (P < .05). CK, CK-MB, LDH, and α-HBDH levels in the severe group were significantly higher than those in the mild group and control group. CK, CK-MB, LDH, and α-HBDH levels in the mild group were higher than those in the control group (P < .05). The severe group had a longer duration of fever, disappearance of symptoms, and cough relief time than the mild group (P < .05). Children with bronchopneumonia exhibit increased cardiac enzyme (CK, CK-MB, LDH, and α-HBDH) activity, and PCT and CRP expression levels increase with disease severity. Timely detection of relevant blood biochemical indicators and early implementation of prevention and treatment measures can improve the cure rate and reduce mortality in children with bronchopneumonia.
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Affiliation(s)
- Yuanyuan Ling
- Department of Pediatrics, The First People’s Hospital of Lin’an District, Hangzhou City, Zhejiang, China
| | - Dean Yang
- Department of Pediatrics, The First People’s Hospital of Lin’an District, Hangzhou City, Zhejiang, China
| | - Sha Yang
- Department of Pediatrics, The First People’s Hospital of Lin’an District, Hangzhou City, Zhejiang, China
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11
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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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12
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Principi N, Autore G, Argentiero A, Esposito S. Short-term antibiotic therapy for the most common bacterial respiratory infections in infants and children. Front Pharmacol 2023; 14:1174146. [PMID: 37346296 PMCID: PMC10279853 DOI: 10.3389/fphar.2023.1174146] [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: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/23/2023] Open
Abstract
Overuse and misuse of antibiotics have strongly accelerated the progressive increase in bacterial antimicrobial resistance (AMR). The evidence that antimicrobial selective pressure was greater the longer the antibiotic therapy was continued has led some experts to reconsider duration of antibiotic therapy testing the use of short-term drug administration. If as effective as long-term therapy, short-term therapy could have been an easy measure to limit AMR emergence. In the present narrative review, whether present knowledge on short-term therapy of acute streptococcal pharyngitis (ASF), acute otitis media (AOM) and mild to moderate community-acquired pneumonia (CAP) allows systematic use of short-term therapy in infants and children with these diseases is discussed. Literature analysis showed that reducing the duration of antibiotic therapy for some of the most common pediatric respiratory infections could be a valid measure to contain the antibiotic abuse and the consequent impact on the emergence of AMR. Several data seem to indicate that this type of intervention is possible, as short-term therapy has been found as effective as the traditionally recommended long-term therapy in some cases of ASF, AOM and mild to moderate CAP. However, further studies are needed to better characterize infants and children who can have benefit with short-term antibiotic therapy in common bacterial respiratory infections.
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Affiliation(s)
| | - Giovanni Autore
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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13
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Meli M, Spicuzza L, Comella M, La Spina M, Trobia GL, Parisi GF, Di Cataldo A, Russo G. The Role of Ultrasound in the Diagnosis of Pulmonary Infection Caused by Intracellular, Fungal Pathogens and Mycobacteria: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13091612. [PMID: 37175003 PMCID: PMC10177819 DOI: 10.3390/diagnostics13091612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is a widely available technique allowing rapid bedside detection of different respiratory disorders. Its reliability in the diagnosis of community-acquired lung infection has been confirmed. However, its usefulness in identifying infections caused by specific and less common pathogens (e.g., in immunocompromised patients) is still uncertain. METHODS This systematic review aimed to explore the most common LUS patterns in infections caused by intracellular, fungal pathogens or mycobacteria. RESULTS We included 17 studies, reporting a total of 274 patients with M. pneumoniae, 30 with fungal infection and 213 with pulmonary tuberculosis (TB). Most of the studies on M. pneumoniae in children found a specific LUS pattern, mainly consolidated areas associated with diffuse B lines. The typical LUS pattern in TB consisted of consolidation and small subpleural nodes. Only one study on fungal disease reported LUS specific patterns (e.g., indicating "halo sign" or "reverse halo sign"). CONCLUSIONS Considering the preliminary data, LUS appears to be a promising point-of-care tool, showing patterns of atypical pneumonia and TB which seem different from patterns characterizing common bacterial infection. The role of LUS in the diagnosis of fungal disease is still at an early stage of exploration. Large trials to investigate sonography in these lung infections are granted.
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Affiliation(s)
- Mariaclaudia Meli
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Lucia Spicuzza
- Pulmology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Mattia Comella
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Milena La Spina
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Gian Luca Trobia
- Pediatrics and Pediatric Emergency Room, Cannizzaro Emergency Hospital, 95126 Catania, Italy
| | - Giuseppe Fabio Parisi
- Pediatric Pulmology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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14
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Ma HR, Deng BY, Liu J, Jiang P, Xu YL, Song XY, Li J, Huang LH, Bao LY, Shan RY, Fu W. Lung ultrasound to diagnose infectious pneumonia of newborns: A prospective multicenter study. Pediatr Pulmonol 2023; 58:122-129. [PMID: 36169007 DOI: 10.1002/ppul.26168] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Whether lung ultrasound (LUS) can be used for pathogenic diagnosis remains controversial. This study was conducted to clarify whether ultrasound has diagnostic value for etiology. METHODS A total of 135 neonatal pneumonia patients with an identified pathogen were enrolled from the newborn intensive care units of 10 tertiary hospitals in China. The study ran from November 2020 to December 2021. The infants were divided into various groups according to pathogens, time of infection, gestational age, and disease severity. The distribution of pleural line abnormalities, B-line signs, and pulmonary consolidation, as well as the incidence of air bronchogram and pleural effusion based on LUS, were compared between these groups. RESULTS There were significant differences in pulmonary consolidation. The sensitivity and specificity of the diagnosis of severe pneumonia based on the extent of pulmonary consolidation were 83.3% and 85.2%, respectively. The area under the receiver operating characteristic curve for the identification of mild or severe pneumonia based on the distribution of pulmonary consolidation was 0.776. CONCLUSION LUS has good performance in diagnosing and differentiating the severity of neonatal pneumonia but cannot be used for pathogenic identification in the early stages of pneumonia.
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Affiliation(s)
- Hai-Ran Ma
- Department of Paediatrics, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Central People's Hospital, Huizhou, China
| | - Bi-Ying Deng
- Department of Neonatal Intensive Care Unit, Dongguan Children's Hospital, Guangdong Medical University, Dongguan, China
| | - Jing Liu
- Department of Paediatrics, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Jiang
- Department of Paediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Yan-Lei Xu
- Department of Neonatology and Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiu-Yun Song
- Children's hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China
| | - Jie Li
- Department of Neonatology, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Li-Han Huang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen university, Xiamen key laboratory of perinatal-neonatal infection, Xiamen, China
| | - Ling-Yun Bao
- Department of Neonatology, Kunming Children's Hospital, Kunming, China
| | - Rui-Yan Shan
- Department of Pediatrics, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Wei Fu
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
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15
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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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16
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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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17
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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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18
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Lung Ultrasound in Adults and Children with COVID-19: From First Discoveries to Recent Advances. J Clin Med 2022; 11:jcm11154340. [PMID: 35893430 PMCID: PMC9331199 DOI: 10.3390/jcm11154340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/24/2022] [Indexed: 02/04/2023] Open
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19
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Mehrabi S, Rahmanian J, Jalli R. The Accuracy of Lung Ultrasonography Diagnosis of Community-Acquired Pneumonia, in an Adult Cohort. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221115197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Community-acquired pneumonia (CAP) is a common respiratory infection, and diagnosis is frequently performed using a chest radiography (CXR). Sonography is an available method with less radiation exposure, but has not been confirmed for diagnosis of CAP. The objective was to compare the diagnostic accuracy of sonography. Materials and Methods: In this cross-sectional study, 90 adult patients (aged >18 years) were admitted to the emergency department of two university-affiliated hospitals in Southwest Iran, from July to December 2019, with a confirmed diagnosis of CAP. The patient symptoms and CXR results were included as part of this study. Within 24 hours after obtaining a CXR, a lung ultrasonogram (LUS) was performed. The diagnostic accuracy of semiquantitative LUS (SQLUS) was compared with CXR results using the Pearson chi-square test and Fisher’s exact test. Results: The mean age of participants was 52.98 ± 16.77 years. 51 were men (56.7%). 28 patients (31.1%), who had abnormal SQLUS results, were not associated with CXR findings ( P = .296). SQLUS showed poor diagnostic accuracy for LUS (31.11%). Conclusion: This study results could not confirm LUS as an accurate method for diagnosing CAP in adult patients; although due to the convenient sample of adults and clinical-based diagnosis of CAP, any generalization of the results should be made with caution.
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Affiliation(s)
- Samrad Mehrabi
- Division of Pulmonology, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jila Rahmanian
- Division of Pulmonology, Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jalli
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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20
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Buonsenso D, De Rose C, Morello R, Lazzareschi I, Valentini P. Aspiration pneumonia in children with neurological disorders: a new indication for lung ultrasound? A case series. J Ultrasound 2022; 25:325-331. [PMID: 32757145 PMCID: PMC9148346 DOI: 10.1007/s40477-020-00520-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/28/2020] [Indexed: 12/27/2022] Open
Abstract
Aspiration pneumonia is a common cause of morbidity and mortality in both adults and children that, however, is difficult to accurately diagnose. In current literature, there are no reports or clinical research study focused on the possible use of lung ultrasound (LUS) in the diagnosis and follow-up of aspiration pneumonia in children. In this case series, we describe clinical, laboratory, radiological results as well as detailed lung ultrasound findings of three children with severe disability and diagnosed with aspiration pneumonia. In these three cases, albeit at different times, LUS played an important role in both the initial diagnostic process and follow-up.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina De Rose
- 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
| | - Ilaria Lazzareschi
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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21
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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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22
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Elabbas A, Choudhary R, Gullapalli D, Mistry S, M.H F, Mallick AH, Kevu EP, Asif J, Mostafa JA. Lung Ultrasonography Beyond the Diagnosis of Pediatrics Pneumonia. Cureus 2022; 14:e22460. [PMID: 35371734 PMCID: PMC8942135 DOI: 10.7759/cureus.22460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
Abstract
Pneumonia is a prevalent disease with considerable morbidity and mortality among the pediatric population. Early diagnosis and swift commencement of the correct treatment are vital for a favorable clinical outcome. Along with history-taking and clinical examination, imaging modalities commonly used, lung ultrasound provides a bedside, less invasive, radiation-free alternative to diagnose pneumonia when compared with other images such as chest x-ray (CXR) and computed tomography (CT) scan. It is therefore of the utmost magnitude to inspect the evidence of its accuracy and reliability in the diagnosis of this condition. The goal of this study is to look into the available data supporting the use of lung ultrasound in the diagnosis of juvenile pneumonia, its relevance in distinguishing between viral and bacterial diseases, and its superiority as compared to other diagnostic methods. As mentioned, early detection and differentiation of the type of pneumonia can reduce unnecessary antibiotic prescriptions and provide patients with a better prognosis, as well as the ability to predict the course of the disease and the need for advanced care or the development of complications. An extensive literature search of two popular online medical websites (PubMed and Embase) was conducted in this review, concentrating on studies that examined the role of lung ultrasound in the diagnosis of pediatric pneumonia published in the last five years. Only studies published in the English language were included in this review. With high sensitivity and specificity, lung ultrasound appeared to be a promising tool not only for pediatric pneumonia diagnosis, but also for treatment guidance and disease follow-up, especially when combined with clinical presentation and laboratory findings.
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23
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De Rose C, Miceli Sopo S, Valentini P, Morello R, Biasucci D, Buonsenso D. Potential Application of Lung Ultrasound in Children with Severe Uncontrolled Asthma: Preliminary Hypothesis Based on a Case Series. MEDICINES 2022; 9:medicines9020011. [PMID: 35200755 PMCID: PMC8877587 DOI: 10.3390/medicines9020011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022]
Abstract
In recent years, lung ultrasound (LUS) has been increasingly used for the diagnosis of respiratory diseases in both adult and pediatric patients. However, asthma is a field in which the use of LUS is not yet well defined, or is in development. In the following case series, we describe clinical, laboratory, and radiological results, as well as detailed lung ultrasound findings of six children with asthma: some of them with acute asthma attack and with inadequately controlled allergic asthma or childhood asthma; others with acute asthma and allergic or infantile asthma adequately controlled by preventive therapy. Finally, we describe the clinical, laboratory, and imaging parameters of a child with severe allergic asthma in the absence of exacerbation. In these cases, albeit at different times, LUS played an important role in both the initial diagnostic process and follow-up. It also showed different ultrasound features depending on the severity of the individual asthma based on the type of asthmatic phenotype and control of it.
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Affiliation(s)
- Cristina De Rose
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
- Correspondence: ; Tel.: +32-7661-4543 or +39-06-3015-4390; Fax: +39-06-338-3211
| | - Stefano Miceli Sopo
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
| | - Daniele Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Rome, Italy;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
- Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of Sacre Hearth, 00168 Rome, Italy
- Global Health Research Institute, Institute of Hygiene, Catholic University of Sacre Hearth, 00168 Rome, Italy
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24
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Buonsenso D, De Rose C, Ferro V, Morello R, Musolino A, Valentini P. Lung ultrasound to detect cardiopulmonary interactions in acutely ill children. Pediatr Pulmonol 2022; 57:483-497. [PMID: 34761881 DOI: 10.1002/ppul.25755] [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: 06/23/2021] [Revised: 09/28/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE AND DESIGN Our prospective observational study is the first study that evaluates the lung ultrasound (LUS) findings of cardiopulmonary interactions in acutely ill children with elevated pro-brain natriuretic peptide (BNP) levels, with the aim of establishing the specific LUS pattern in this category of patients without primary lung diseases. METHODOLOGY We prospectively analyzed epidemiological, clinical, laboratory, instrumental, and lung ultrasound parameters in acutely ill children aged 1 month to 18 years admitted to the Department of Pediatrics between March 2020 to August 2020. Among the acutely ill patients evaluated, only patients with pro-BNP > 300 pg/ml and who underwent LUS before the start of any treatment were included. They were stratified into three subcategories based on the diagnosis (A) cardiac disease, (B) systemic inflammatory disease/sepsis without functional and/or organic alterations of the myocardium, and (C) systemic inflammatory disease/sepsis and cardiac disease, and were classified into two groups based on the level of pro-BNP. We also enrolled patients belonging to two other categories (patients with primary infectious lung disease and completely healthy patients) analyzing their epidemiological, clinical, laboratory, instrumental parameters, and lung ultrasound findings and comparing them with those of acutely ill children. RESULTS AND CONCLUSION We found that LUS findings in these acutely ill children are different from the ultrasound pattern of other categories of children and in particular (1) children with acute lower respiratory tract infections and (2) healthy infants. The finding in a child of a sonographic interstitial syndrome with multiple, bright, long, separate, and nonconfluent B-lines/long vertical artifacts deriving from a normal and regular pleural line, in the absence of subpleural consolidations, is strongly predictive of cardiogenic pulmonary edema or pulmonary congestion in the course of systemic inflammatory disease/sepsis.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, 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, Roma, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Valentina Ferro
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Annamaria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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25
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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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26
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Mvalo T, McCollum ED, Fitzgerald E, Kamthunzi P, Schmicker RH, May S, Phiri M, Chirombo C, Phiri A, Ginsburg AS. Chest radiography in children aged 2-59 months enrolled in the Innovative Treatments in Pneumonia (ITIP) project in Lilongwe Malawi: a secondary analysis. BMC Pediatr 2022; 22:31. [PMID: 35012490 PMCID: PMC8744340 DOI: 10.1186/s12887-021-03091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pneumonia is the leading infectious cause of death in children aged under 5 years in low- and middle-income countries (LMICs). World Health Organization (WHO) pneumonia diagnosis guidelines rely on non-specific clinical features. We explore chest radiography (CXR) findings among select children in the Innovative Treatments in Pneumonia (ITIP) project in Malawi in relation to clinical outcomes. METHODS When clinically indicated, CXRs were obtained from ITIP-enrolled children aged 2 to 59 months with community-acquired pneumonia hospitalized with treatment failure or relapse. ITIP1 (fast-breathing pneumonia) and ITIP2 (chest-indrawing pneumonia) trials enrolled children with non-severe pneumonia while ITIP3 enrolled children excluded from ITIP1 and ITIP2 with severe pneumonia and/or selected comorbidities. A panel of trained pediatricians classified the CXRs using the standardized WHO CXR research methodology. We analyzed the relationship between CXR classifications, enrollee characteristics, and outcomes. RESULTS Between March 2016 and June 2018, of 114 CXRs obtained, 83 met analysis criteria with 62.7% (52/83) classified as having significant pathology per WHO standardized interpretation. ITIP3 (92.3%; 12/13) children had a higher proportion of CXRs with significant pathology compared to ITIP1 (57.1%, 12/21) and ITIP2 (57.1%, 28/49) (p-value = 0.008). The predominant pathological CXR reading was "other infiltrates only" in ITIP1 (83.3%, 10/12) and ITIP2 (71.4%, 20/28), while in ITIP3 it was "primary endpoint pneumonia"(66.7%, 8/12,; p-value = 0.008). The percent of CXRs with significant pathology among children clinically cured (60.6%, 40/66) vs those not clinically cured (70.6%, 12/17) at Day 14 was not significantly different (p-value = 0.58). CONCLUSIONS In this secondary analysis we observed that ITIP3 children with severe pneumonia and/or selected comorbidities had a higher frequency of CXRs with significant pathology, although these radiographic findings had limited relationship to Day 14 outcomes. The proportion of CXRs with "primary endpoint pneumonia" was low. These findings add to existing data that additional diagnostics and prognostics are important for improving the care of children with pneumonia in LMICs. TRIAL REGISTRATION ITIP1, ITIP2, and ITIP3 were registered with ClinicalTrials.gov ( NCT02760420 , NCT02678195 , and NCT02960919 , respectively).
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Affiliation(s)
- Tisungane Mvalo
- Lilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi.
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Eric D McCollum
- Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Fitzgerald
- Lilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Portia Kamthunzi
- Lilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert H Schmicker
- University of Washington Clinical Trial Center, Seattle, Washington, USA
| | - Susanne May
- University of Washington Clinical Trial Center, Seattle, Washington, USA
| | - Melda Phiri
- Lilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi
| | - Claightone Chirombo
- Lilongwe Medical Relief Fund Trust, University of North Carolina Project, Lilongwe, Malawi
| | - Ajib Phiri
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Lilongwe Campus, Lilongwe, Malawi
| | - Amy Sarah Ginsburg
- University of Washington Clinical Trial Center, Seattle, Washington, USA
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27
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Fiorito I, Gori G, Perrone T, Mascolo A, Caimmi S, Palumbo I, De Silvestri A, Delliponti M, Di Sabatino A, Marseglia GL. ECHOPAEDIA: Echography in Paediatric Patients in the Age of Coronavirus Disease 2019: Utility of Lung Ultrasound and Chest X-Ray in Diagnosis of Community-Acquired Pneumonia and Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia. Front Pediatr 2022; 10:813874. [PMID: 35295703 PMCID: PMC8918613 DOI: 10.3389/fped.2022.813874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, lung ultrasound (LUS) has spread to emergency departments and clinical practise gaining great support, especially in time of pandemic, but only a few studies have been done on children. The aim of the present study is to compare the diagnostic accuracy of LUS (using Soldati LUS score) and that of chest X-ray (CXR) in CAP and COVID-19 pneumonia in paediatric patients. Secondary objective of the study is to examine the association between LUS score and disease severity. Finally, we describe the local epidemiology of paediatric CAP during the study period in the era of COVID-19 by comparing it with the previous 2 years. METHODS This is an observational retrospective single-centre study carried out on patients aged 18 or younger and over the month of age admitted to the Paediatric Unit of our Foundation for suspected community-acquired pneumonia or SARS-CoV-2 pneumonia during the third pandemic wave of COVID-19. Quantitative variables were elaborated with Shapiro-Wilks test or median and interquartile range (IQR). Student's t-test was used for independent data. Association between quantitative data was evaluated with Pearson correlation. ROC curve analysis was used to calculate best cut-off of LUS score in paediatric patients. Area under the ROC curve (AUC), sensibility, and specificity are also reported with 95% confidence interval (CI). RESULTS The diagnostic accuracy of the LUS score in pneumonia, the area underlying the ROC curve (AUC) was 0.67 (95% CI: 0.27-1) thus showing a discrete discriminatory power, with a sensitivity of 89.66% and specificity 50% setting a LUS score greater than or equal to 1 as the best cut-off. Nine patients required oxygen support and a significant statistical correlation (p = 0.0033) emerged between LUS score and oxygen therapy. The mean LUS score in patients requiring oxygen therapy was 12. RCP was positively correlated to the patient's LUS score (p = 0.0024). CONCLUSIONS Our study has shown that LUS is a valid alternative to CXR. Our results show how LUS score can be applied effectively for the diagnosis and stratification of paediatric pneumonia.
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Affiliation(s)
- Ivan Fiorito
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giulia Gori
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Amelia Mascolo
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Silvia Caimmi
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ilaria Palumbo
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Annalisa De Silvestri
- Unit of Clinical Epidemiology and Biometrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mariangela Delliponti
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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28
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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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Attanasi M, Sferrazza Papa S, Porreca A, Sferrazza Papa GF, Di Filippo P, Piloni F, Dodi G, Sansone F, Di Pillo S, Chiarelli F. Use of lung ultrasound in school-aged children with wheezing. Front Pediatr 2022; 10:926252. [PMID: 36699291 PMCID: PMC9869023 DOI: 10.3389/fped.2022.926252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is limited information available on fast and safe bedside tools that could help clinicians establish whether the pathological process underlying cases of wheezing is due to asthmatic exacerbation, asthmatic bronchitis, or pneumonia. The study's aim was to characterize Lung Ultrasound (LUS) in school-aged children with wheezing and evaluate its use for their follow-up treatment. MATERIALS AND METHODS We carried out a cross-sectional study involving 68 consecutive outpatients (mean age 9.9 years) with wheezing and suggestive signs of an acute respiratory infection. An expert sonographer, blinded to all subject characteristics, clinical course, and the study pediatrician's diagnosis, performed an LUS after spirometry and before BDT. The severity of acute respiratory symptoms was determined using the Pediatric Respiratory Assessment Measure (PRAM) score. RESULTS The LUS was positive in 38.2% (26/68) of patients [12 (46.1%) with multiple B-lines, 24 (92.3%) with consolidation, and 22 (84.6%) with pleural abnormalities]. In patients with pneumonia, asthmatic bronchitis, and asthma, the percentages of those patients with a positive LUS were 100%, 57.7%, and 0%, respectively. Of note, patients with a positive LUS were associated with an increased need for hospital admission (30.8% vs. 2.4%, p = 0.001), administration of oxygen therapy (14.6% vs. 0%, p = 0.009), oral corticosteroids (84.6% vs. 19.0%, p < 0.001), and antibiotics (88.5% vs. 11.9%, p < 0.001); and a higher median value of PRAM score (4.0 (2.0-7.0) vs. 2.0 (1.0-5.0); p < 0.001). CONCLUSIONS Our findings would suggest the use of LUS as a safe and cheap tool used by clinicians to define the diagnosis of school-aged children with wheezing of unknown causes.
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Affiliation(s)
- Marina Attanasi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Simone Sferrazza Papa
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe F Sferrazza Papa
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Paola Di Filippo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesca Piloni
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Giulia Dodi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Sansone
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
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Buonsenso D, De Rose C. Implementation of lung ultrasound in low- to middle-income countries: a new challenge global health? Eur J Pediatr 2022; 181:1-8. [PMID: 34216270 PMCID: PMC8254441 DOI: 10.1007/s00431-021-04179-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. What is Known: • Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. What is New: • We discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, Largo A. Gemelli 8, 00168, 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.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, Largo A. Gemelli 8, 00168, Rome, Italy
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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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Roshandel J, Alahyari S, Khazaei M, Asgari R, Moharamzad Y, Zarei E, Sanei Taheri M. Diagnostic performance of lung ultrasound compared to CT scan in the diagnosis of pulmonary lesions of COVID-19 induced pneumonia: a preliminary study. Virusdisease 2021; 32:674-680. [PMID: 34426793 PMCID: PMC8372226 DOI: 10.1007/s13337-021-00736-w] [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: 04/25/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
Chest CT scan is currently used to assess the extent of lung involvement in patients with the coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the diagnostic performance of lung ultrasound in the diagnosis of COVID-19 pulmonary manifestations in comparison to CT scan. Thirty-three symptomatic patients with suspected COVID-19 pneumonia were evaluated by lung ultrasound and then, at a short interval, chest CT scan. In the anterior chest, each hemithorax was divided into four areas. In the posterior chest, eight zones similar to the anterior part were examined. The axillary areas were also divided into upper and lower zones (20 zones were determined per patient). Mean age of the patients was 58.66 years. The sensitivity (95% CI) and specificity (95% CI) of lung ultrasound for the diagnosis of parenchymal lesions were 90.5% (69.6-98.8%) and 50% (21.1-78.9%), respectively. In the evaluation of pleural lesions, the sensitivity (95% CI) and specificity (95% CI) of lung ultrasound were 100% (71.5-100%) and 22.7% (7.8-45.4%), respectively. Owing to the high sensitivity of ultrasound in identifying lung lesions in patients with COVID-19 pneumonia, it can be recommended to use lung ultrasound as a tool for initial screening of patients with high clinical suspicion for SARS-CoV-2 infection during the pandemic. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13337-021-00736-w.
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Affiliation(s)
- Jafar Roshandel
- Radiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khazaei
- Radiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhane Asgari
- Radiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yashar Moharamzad
- Radiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Zarei
- Radiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei Taheri
- Radiology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hassanzad M, Kiani A, Abedini A, Ghaffaripour H, Emami H, Alizadeh N, Zoghi G, Hashemi S, Velayati AA. Lung ultrasound for the diagnosis of cystic fibrosis pulmonary exacerbation. BMC Pulm Med 2021; 21:353. [PMID: 34743707 PMCID: PMC8572653 DOI: 10.1186/s12890-021-01728-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/03/2021] [Indexed: 01/03/2023] Open
Abstract
Background High-resolution computed tomography (HRCT) is the gold standard for the evaluation of cystic fibrosis (CF) lung disease; however, lung ultrasound (LUS) is being increasingly used for the assessment of lung in these patients due to its lower cost, availability, and lack of irradiation. We aimed to determine the diagnostic performance of LUS for the evaluation of CF pulmonary exacerbation. Methods This cross-sectional study included patients with CF pulmonary exacerbation admitted to Masih Daneshvari Hospital, Tehran, Iran, from March 21, 2020 to March 20, 2021. Age, gender, and body mass index (BMI) of the patients were recorded. All patients underwent chest X-ray (CXR), HRCT, and LUS on admission. Pleural thickening, atelectasis, air bronchogram, B-line, and consolidation were noted in LUS and then compared with the corresponding findings in CXR and HRCT. Taking HRCT findings as reference, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of LUS and CXR for the detection of each pulmonary abnormality were determined. Results Of the 30 patients included in this study, with a mean age of 19.62 ± 5.53 years, 14 (46.7%) were male. Of the 15 patients aged 2–20 years, BMI was below the 5th percentile in 10 (66.7%), within the 5–10 percentiles in 1 (6.7%), 10–25 percentiles in 3 (20%), and 25-50 percentiles in 1 (6.7%). The mean BMI for 15 patients > 20 years was 18.03 ± 2.53 kg/m2. LUS had better diagnostic performance compared to CXR for the detection of air bronchogram, consolidation, and pleural thickening (area under the receiver operating characteristic curve [AUROC]: 0.966 vs. 0.483, 0.900 vs. 0.575, and 0.656 vs. 0.531, respectively). Also, LUS was 100% and 96.7% specific for the diagnosis of pleural effusion and atelectasis, respectively. Conclusions LUS appears to be superior to CXR and comparable with HRCT for the evaluation of CF pulmonary exacerbation, especially in terms of air bronchogram and consolidation detection. LUS can be used to lengthen the HRCT evaluation intervals in this regard or utilized along with HRCT for better evaluation of CF pulmonary exacerbation.
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Affiliation(s)
- Maryam Hassanzad
- Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hoseinali Ghaffaripour
- Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Alizadeh
- Department of Biostatistics, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Saeed Hashemi
- Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Akbar Velayati
- Mycobacteriology Research Center (MRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ishac D, Matta S, Bin S, Aziz H, Karam E, Abche A, Nassar G. Objective Assessment of Covid-19 Severity Affecting the Vocal and Respiratory System Using a Wearable, Autonomous Sound Collar. Cell Mol Bioeng 2021; 15:67-86. [PMID: 34777597 PMCID: PMC8570400 DOI: 10.1007/s12195-021-00712-w] [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: 03/04/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Since the outbreak began in January 2020, Covid-19 has affected more than 161 million people worldwide and resulted in about 3.3 million deaths. Despite efforts to detect human infection with the virus as early as possible, the confirmatory test still requires the analysis of sputum or blood with estimated results available within approximately 30 minutes; this may potentially be followed by clinical referral if the patient shows signs of aggravated pneumonia. This work aims to implement a soft collar as a sound device dedicated to the objective evaluation of the pathophysiological state resulting from dysphonia of laryngeal origin or respiratory failure of inflammatory origin, in particular caused by Covid-19. Methods In this study, we exploit the vibrations of waves generated by the vocal and respiratory system of 30 people. A biocompatible acoustic sensor embedded in a soft collar around the neck collects these waves. The collar is also equipped with thermal sensors and a cross-data analysis module in both the temporal and frequency domains (STFT). The optimal coupling conditions and the electrical and dimensional characteristics of the sensors were defined based on a mathematical approach using a matrix formalism. Results The characteristics of the signals in the time domain combined with the quantities obtained from the STFT offer multidimensional information and a decision support tool for determining a pathophysiological state representative of the symptoms explored. The device, tested on 30 people, was able to differentiate patients with mild symptoms from those who had developed acute signs of respiratory failure on a severity scale of 1 to 10. Conclusion With the health constraints imposed by the effects of Covid-19, the heavy organization to be implemented resulting from the flow of diagnostics, tests and clinical management, it was urgent to develop innovative and safe biomedical technologies. This passive listening technique will contribute to the non-invasive assessment and dynamic observation of lesions. Moreover, it merits further examination to provide support for medical operators to improve clinical management. Supplementary Information The online version contains supplementary material available at 10.1007/s12195-021-00712-w.
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Affiliation(s)
- D Ishac
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - S Matta
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - S Bin
- College of Physics, University of Qingdao, Qingdao, China
| | - H Aziz
- Department of Pulmonary Pathology, Sahlgrenska University Hospital, Göteborg, Sweden
| | - E Karam
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - A Abche
- Electrical Engineering Department, University of Balamand (UOB), Balamand, Lebanon
| | - G Nassar
- IEMN - CNRS UMR 8520-INSA (HdF)-Lille academic, Lille, France
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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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Antonitsch L, Gallob R, Weidinger G, Kettenbach J. New insights and antimicrobial stewardship opportunities in viral pneumonia: five lung ultrasound cases. Wien Klin Wochenschr 2021; 133:1208-1214. [PMID: 34605974 PMCID: PMC8488548 DOI: 10.1007/s00508-021-01946-4] [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: 01/23/2021] [Accepted: 08/25/2021] [Indexed: 01/08/2023]
Abstract
Background Antimicrobial stewardship is crucial to avoid antimicrobial resistance in microbes and adverse drug effects in patients. In respiratory infections, however, viral pneumonia is difficult to distinguish from bacterial pneumonia, which explains the overuse of antibiotic therapy in this indication. Cases Five cases of lung consolidation are presented. Lung ultrasound, in conjunction with procalcitonin levels, were used to exclude or corroborate bacterial pneumonia. Conclusion Lung ultrasound is easy to learn and perform and is helpful in guiding diagnosis in unclear cases of pneumonia and may also offer new insights into the spectrum of certain virus diseases. The use of lung ultrasound can raise awareness in clinicians of the need for antimicrobial stewardship and may help to avoid the unnecessary use of antibiotics. Supplementary Information The online version of this article (10.1007/s00508-021-01946-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Antonitsch
- Department of Internal Medicine and Gastroenterology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria.
| | - Ronald Gallob
- Department of Anesthesia, Emergency Medicine and Intensive Care, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Gerhard Weidinger
- Department of Internal Medicine and Gastroenterology, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
| | - Joachim Kettenbach
- Institute of Diagnostic, Interventional Radiology and Nuclear Medicine, Landesklinikum Wiener Neustadt, Corvinusring 3-5, 2700, Wiener Neustadt, Austria
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Sansone F, Attanasi M, Di Filippo P, Sferrazza Papa GF, Di Pillo S, Chiarelli F. Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases. Diagnostics (Basel) 2021; 11:1783. [PMID: 34679481 PMCID: PMC8534634 DOI: 10.3390/diagnostics11101783] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/02/2023] Open
Abstract
Respiratory infection diseases are among the major causes of morbidity and mortality in children. Diagnosis is focused on clinical presentation, yet signs and symptoms are not specific and there is a need for new non-radiating diagnostic tools. Among these, lung ultrasound (LUS) has recently been included in point-of-care protocols showing interesting results. In comparison to other imaging techniques, such as chest X-ray and computed tomography, ultrasonography does not use ionizing radiations. Therefore, it is particularly suitable for clinical follow-up of paediatric patients. LUS requires only 5-10 min and allows physicians to make quick decisions about the patient's management. Nowadays, LUS has become an early diagnostic tool to detect pneumonia during the COVID-19 pandemic. In this narrative review, we show the most recent scientific literature about advantages and limits of LUS performance in children. Furthermore, we discuss the major paediatric indications separately, with a paragraph fully dedicated to COVID-19. Finally, we mention potential future perspectives about LUS application in paediatric respiratory diseases.
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Affiliation(s)
- Francesco Sansone
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Marina Attanasi
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Paola Di Filippo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Giuseppe Francesco Sferrazza Papa
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20146 Milan, Italy;
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, 20144 Milan, Italy
| | - Sabrina Di Pillo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Francesco Chiarelli
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
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Magrelli S, Valentini P, De Rose C, Morello R, Buonsenso D. Classification of Lung Disease in Children by Using Lung Ultrasound Images and Deep Convolutional Neural Network. Front Physiol 2021; 12:693448. [PMID: 34512375 PMCID: PMC8432935 DOI: 10.3389/fphys.2021.693448] [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] [Received: 04/11/2021] [Accepted: 08/05/2021] [Indexed: 01/12/2023] Open
Abstract
Bronchiolitis is the most common cause of hospitalization of children in the first year of life and pneumonia is the leading cause of infant mortality worldwide. Lung ultrasound technology (LUS) is a novel imaging diagnostic tool for the early detection of respiratory distress and offers several advantages due to its low-cost, relative safety, portability, and easy repeatability. More precise and efficient diagnostic and therapeutic strategies are needed. Deep-learning-based computer-aided diagnosis (CADx) systems, using chest X-ray images, have recently demonstrated their potential as a screening tool for pulmonary disease (such as COVID-19 pneumonia). We present the first computer-aided diagnostic scheme for LUS images of pulmonary diseases in children. In this study, we trained from scratch four state-of-the-art deep-learning models (VGG19, Xception, Inception-v3 and Inception-ResNet-v2) for detecting children with bronchiolitis and pneumonia. In our experiments we used a data set consisting of 5,907 images from 33 healthy infants, 3,286 images from 22 infants with bronchiolitis, and 4,769 images from 7 children suffering from bacterial pneumonia. Using four-fold cross-validation, we implemented one binary classification (healthy vs. bronchiolitis) and one three-class classification (healthy vs. bronchiolitis vs. bacterial pneumonia) out of three classes. Affine transformations were applied for data augmentation. Hyperparameters were optimized for the learning rate, dropout regularization, batch size, and epoch iteration. The Inception-ResNet-v2 model provides the highest classification performance, when compared with the other models used on test sets: for healthy vs. bronchiolitis, it provides 97.75% accuracy, 97.75% sensitivity, and 97% specificity whereas for healthy vs. bronchiolitis vs. bacterial pneumonia, the Inception-v3 model provides the best results with 91.5% accuracy, 91.5% sensitivity, and 95.86% specificity. We performed a gradient-weighted class activation mapping (Grad-CAM) visualization and the results were qualitatively evaluated by a pediatrician expert in LUS imaging: heatmaps highlight areas containing diagnostic-relevant LUS imaging-artifacts, e.g., A-, B-, pleural-lines, and consolidations. These complex patterns are automatically learnt from the data, thus avoiding hand-crafted features usage. By using LUS imaging, the proposed framework might aid in the development of an accessible and rapid decision support-method for diagnosing pulmonary diseases in children using LUS imaging.
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Affiliation(s)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina De Rose
- 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
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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Lopez RW, Hysell MK, Long JP, Longobardi J. Legionella Pneumonia on Point-of-care Ultrasound in the Emergency Department: A Case Report. Clin Pract Cases Emerg Med 2021; 5:155-158. [PMID: 34436993 PMCID: PMC8143842 DOI: 10.5811/cpcem.2021.1.50314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Legionella is an uncommon, atypical organism that can cause community-acquired pneumonia. Commonly associated with high fevers, gastrointestinal symptoms, and hyponatremia, it can be easily overlooked, especially during the coronavirus disease of 2019 (COVID-19) pandemic. Legionella has specific antibiotic treatment that will improve outcome; thus, its recognition is important. Case Report We present a case of Legionella pneumonia in a man presenting with shortness of breath and fever. The patient’s initial chest radiography was negative. With the use of point-of-care ultrasound (POCUS) the changes of atypical pneumonia could be seen. Ultimately Legionella was confirmed with urine antigen testing, and appropriate antibiotic treatment was started. Discussion Given the increased awareness of COVID-19 it is important to consider a broad differential with respiratory illness. Legionella pneumonia on POCUS is consistent with atypical pneumonia descriptions on ultrasound. Point-of-care ultrasound can be used to diagnose atypical pneumonia, specifically caused by Legionella in our case. Conclusion Legionella is evident on POCUS but is difficult to distinguish from other infections with POCUS alone. One should consider Legionella if POCUS is positive for signs of atypical infection.
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Affiliation(s)
- Robert W Lopez
- Des Moines University College of Osteopathic Medicine, Des Moines, Iowa
| | - Matthew K Hysell
- Spectrum Health - Lakeland, Emergency Medicine, St. Joseph, Michigan
| | - Jereme P Long
- Spectrum Health - Lakeland, Emergency Medicine, St. Joseph, Michigan
| | - Joseph Longobardi
- Spectrum Health - Lakeland, Emergency Medicine, St. Joseph, Michigan
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Lacedonia D, Quarato CMI, Mirijello A, Trovato GM, Del Colle A, Rea G, Scioscia G, Foschino Barbaro MP, Sperandeo M. COVID-19 Pneumonia: The Great Ultrasonography Mimicker. Front Med (Lausanne) 2021; 8:709402. [PMID: 34513877 PMCID: PMC8424049 DOI: 10.3389/fmed.2021.709402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/30/2021] [Indexed: 12/14/2022] Open
Abstract
The pandemic spread of the new severe acute respiratory syndrome coronavirus 2 has raised the necessity to identify an appropriate imaging method for early diagnosis of coronavirus disease 2019 (COVID-19). Chest computed tomography (CT) has been regarded as the mainstay of imaging evaluation for pulmonary involvement in the early phase of the pandemic. However, due to the poor specificity of the radiological pattern and the disruption of radiology centers' functionality linked to an excessive demand for exams, the American College of Radiology has advised against CT use for screening purposes. Lung ultrasound (LUS) is a point-of-care imaging tool that is quickly available and easy to disinfect. These advantages have determined a "pandemic" increase of its use for early detection of COVID-19 pneumonia in emergency departments. However, LUS findings in COVID-19 patients are even less specific than those detectable on CT scans. The scope of this perspective article is to discuss the great number of diseases and pathologic conditions that may mimic COVID-19 pneumonia on LUS examination.
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Affiliation(s)
- Donato Lacedonia
- COVID-19 Center, Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, Foggia, Italy
| | - Carla Maria Irene Quarato
- COVID-19 Center, Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, Foggia, Italy
| | - Antonio Mirijello
- COVID-19 Unit, Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Anna Del Colle
- COVID-19 Center, Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, Foggia, Italy
| | - Gaetano Rea
- Department of Radiology, Azienda Ospedaliera dei Colli-Cotugno and Monaldi Hospital, Napoli, Italy
| | - Giulia Scioscia
- COVID-19 Center, Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Universitario “Riuniti” di Foggia, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- COVID-19 Unit, Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound, Department of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
- Professor of Diagnostic and Interventional Lung Ultrasonography at the Bachelor in Medicine and Surgery and the Postgraduate School of Respiratory Disease, University of Foggia, Foggia, Italy
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Lung ultrasound may support internal medicine physicians in predicting the diagnosis, bacterial etiology and favorable outcome of community-acquired pneumonia. Sci Rep 2021; 11:17016. [PMID: 34426615 PMCID: PMC8382746 DOI: 10.1038/s41598-021-96380-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022] Open
Abstract
To assess the usefulness of lung ultrasound (LUS) for identifying community-acquired pneumonia (CAP) among adult patients with suspected lower respiratory tract infection (LRTI) and for discriminating between CAP with different cultural statuses, etiologies, and outcomes. LUS was performed at internal medicine ward admission. The performance of chest X-ray (CXR) and LUS in diagnosing CAP in 410 patients with suspected LRTI was determined. All possible positive results for pneumonia on LUS were condensed into pattern 1 (consolidation + / − alveolar-interstitial syndrome) and pattern 2 (alveolar-interstitial syndrome). The performance of LUS in predicting culture-positive status, bacterial etiology, and adverse outcomes of CAP was assessed in 315 patients. The area under the receiver operating characteristic curve for diagnosing CAP by LUS was significantly higher than for diagnosis CAP by CXR (0.93 and 0.71, respectively; p < 0.001). Pattern 1 predicted CAP with bacterial and mixed bacterial and viral etiologies with positive predictive values of 99% (95% CI, 94–100%) and 97% (95% CI, 81–99%), respectively. Pattern 2 ruled out mortality with a negative predictive value of 95% (95% CI, 86–98%), respectively. In this study, LUS was useful in predicting a diagnosis of CAP, the bacterial etiology of CAP, and favorable outcome in patients with CAP.
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Dacrema A, Silva M, Rovero L, Vertemati V, Losi G, Piepoli MF, Sacchi R, Mangiacotti M, Nazerian P, Pagani L, Tinelli V, Poggiali E, Bastoni D, Vercelli A, Magnacavallo A. A simple lung ultrasound protocol for the screening of COVID-19 pneumonia in the emergency department. Intern Emerg Med 2021; 16:1297-1305. [PMID: 33428110 PMCID: PMC7797709 DOI: 10.1007/s11739-020-02596-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023]
Abstract
The most relevant manifestation of coronavirus disease 2019 (COVID-19) is interstitial pneumonia. Several lung ultrasound (US) protocols for pneumonia diagnosis are used in clinical practice, but none has been proposed for COVID-19 patients' screening in the emergency department. We adopted a simplified 6-scan lung US protocol for COVID-19 pneumonia diagnosis (LUSCOP) and compared its sensitivity with high resolution computed tomography (HRCT) in patients suspected for COVID-19, presenting to one Emergency Department from February 21st to March 15th, 2020, during the outbreak burst in northern Italy. Patients were retrospectively enrolled if both LUSCOP protocol and HRCT were performed in the Emergency Department. The sensitivity of LUSCOP protocol and HRCT were compared. COVID-19 pneumonia's final diagnosis was based on real-time reverse-transcription polymerase chain reaction from nasal-pharyngeal swab and on clinical data. Out of 150 suspected COVID-19 patients, 131 were included in the study, and 130 had a final diagnosis of COVID-19 pneumonia. The most frequent lung ultrasonographic features were: bilateral B-pattern in 101 patients (77%), B-pattern with subpleural consolidations in 26 (19.8%) and lung consolidations in 2 (1.5%). LUSCOP Protocol was consistent with HRCT in correctly screening 130 out of the 131 COVID-19 pneumonia cases (99.2%). In one case COVID-19 pneumonia was excluded by both HRCT and lung US. LUSCOP protocol showed optimal sensitivity and can be proposed as a simple screening tool for COVID-19 pneumonia diagnosis in the context of outbreak burst areas where prompt isolation of suspected patients is crucial for patients' and operators' safety.
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Affiliation(s)
- Alessandro Dacrema
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Matteo Silva
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Luca Rovero
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Valeria Vertemati
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Giulia Losi
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | | | - Roberto Sacchi
- Earth and Environmental Sciences Department, University of Pavia, Pavia, Italy
| | - Marco Mangiacotti
- Earth and Environmental Sciences Department, University of Pavia, Pavia, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Laura Pagani
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Valentina Tinelli
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Erika Poggiali
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Davide Bastoni
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Andrea Vercelli
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy
| | - Andrea Magnacavallo
- Emergency Department, Guglielmo Da Saliceto Hospital, via Cantone del Cristo 40, 29121, Piacenza, Italy.
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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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De Rose C, Buonsenso D, De Rosa G, Chiaretti A. Clinical applications of Lung Ultrasound in children in Pediatric Emergency Setting: a lesson from a child with severe heart disease. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021209. [PMID: 34212908 PMCID: PMC8343744 DOI: 10.23750/abm.v92i3.11351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
Background and aim: Rheumatic Heart Disease (RHD) often evolves in congestive heart failure with development of pulmonary edema after a asymptomatic, latent phase. In the last years, Lung Ultrasound (LUS) has gained a primary role in the diagnosis and management of pleuropulmonary disorders, also in pediatric practice, and in the diagnosis and follow-up of pulmonary edema through qualitative analysis of ultrasound B-lines. Aim of this case report is to keep high clinicians’ attention to the diagnosis of Rheumatic Heart Disease also in high-income countries and to deepen the role and importance of lung ultrasound in clinical practice, in diagnosis and follow-up of pediatric lung diseases, especially in emergency settings as happened in our case. Methods: We present the case of a 14-year-old Italian boy from a medium-low socio-economic and cultural class Italian family, who was diagnosed with severe and advanced stage RHD, which had remained undiagnosed until then. Results and Conclusions: In the diagnostic process of our case, LUS played a fundamental role because it quickly directed us, contextually to the clinical and anamnestic evaluation, towards the right diagnosis, in a Pediatric Emergency Department. In clinical practice, the only LUS findings and the only qualitative analysis of the B-lines, have note made clinicians able to make a clear characterization yet. Thus, the study of cardiovascular function, laboratory parameters, anamnestic and clinical data continue to be useful tools in order to assist LUS in the diagnostic processes of lung diseases, as in our case. (www.actabiomedica.it)
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Affiliation(s)
- Cristina De Rose
- a:1:{s:5:"en_US";s:46:"Fondazione Policlinico Universitario A.Gemelli";}.
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Role of lung ultrasound for the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children: a prospective study. J Ultrasound 2021; 25:185-197. [PMID: 34146336 PMCID: PMC8213536 DOI: 10.1007/s40477-021-00600-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/29/2021] [Indexed: 12/19/2022] Open
Abstract
Objective and design Our prospective study assesses the role of detailed lung ultrasound (LUS) features to discriminate the etiological diagnosis of acute lower respiratory tract infection (ALRTI) in children. Methodology We analyzed patients aged from 1 month to 17 years admitted between March 2018 and April 2020 who were hospitalized for ALRTI. For all patients, history, clinical parameters, microbiological data, and lung ultrasound data were collected. Patients were stratified into three main groups (“bacterial”, “viral”, “atypical”) according to the presumed microbial etiology and LUS findings evaluated according to the etiological group. Nasopharyngeal swabs were obtained from all patients. A qualitative diagnostic test developed by Nurex S.r.l. was used for identification of bacterial and fungal DNA in respiratory samples. The Seegene Allplex™ Respiratory assays were used for the molecular diagnosis of viral respiratory pathogens. In addition, bacterial culture of blood and respiratory samples were performed, when indicated. Results A total of 186 children with suspected ALRTI (44% female) with an average age of 6 were enrolled in the study. We found that some ultrasound findings as size, number and distribution of consolidations, the position and motion of air bronchograms, pleural effusions and distribution of vertical artifacts significantly differ (p < 0.05) in children with bacterial, viral and atypical ALRTI. Conclusion Our study provides a detailed analysis of LUS features able to predict the ALRTI ethology in children. These findings may help the physicians to better manage a child with ALRTI and to offer personalized approach, from diagnosis to treatment and follow-up.
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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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De Rose C, Pierantoni L, Buonsenso D. COVID-19 and lung ultrasound: reasons why paediatricians can support adult COVID-19 units during critical epidemiologic periods. J Ultrasound 2021; 25:413-417. [PMID: 34046862 PMCID: PMC8159720 DOI: 10.1007/s40477-021-00591-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, S. Orsola University Hospital, Bologna, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. .,Global Health Research Center, Università Cattolica del Sacro Cuore, Roma, Italia. .,Istituto Di Microbiologia, Università Cattolica del Sacro Cuore, Roma, Italia.
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Norbedo S, Blaivas M, Raffaldi I, Caroselli C. Lung Ultrasound Point-of-View in Pediatric and Adult COVID-19 Infection. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:899-908. [PMID: 32894621 DOI: 10.1002/jum.15475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 05/28/2023]
Abstract
From its start in China in December 2019, infection by the new SARS-CoV2 spread fast all over the world. It can present as severe respiratory distress in the elderly or a vasculitis in a child, most of whom are typically completely asymptomatic. This makes infection detection based on clinical grounds exceedingly difficult. Lung ultrasound has become an important tool in diagnosis and follow-up of patient with COVID-19 infection.Here we review available, up to date literature on ultrasound use for COVID-19 suspected pediatric patients and contrast it to published findings in adult patients.
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Affiliation(s)
- Stefania Norbedo
- Emergency Department of Pediatric Hospital IRCCS Burlo Garofolo, Trieste, Italy
| | - Michael Blaivas
- Department of Emergency Medicine, St Francis Hospital, Columbus, Georgia
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina
| | - Irene Raffaldi
- Emergency Department of Regina Margherita Children Hospital, Turin, Italy
| | - Costantino Caroselli
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS- INRCA), Ancona, Italy
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Point-of-care lung and diaphragm ultrasound in a patient with spinal muscular atrophy with respiratory distress type 1. J Ultrasound 2021; 25:395-398. [PMID: 33847972 DOI: 10.1007/s40477-021-00584-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023] Open
Abstract
Spinal muscular atrophy with respiratory distress type 1 (SMARD1, OMIM #604,320), is a rare autosomal recessive disease resulting from degeneration of motor neurons in the anterior horns, which leads irreversible diaphragmatic palsy and progressive distal symmetrical muscular weakness. Respiratory distress is the main symptom and is severe, rapidly progressive, and frequently requiring invasive ventilation. Despite diaphragm being one of the target organ of the disease, no specific study has been done using ultrasound.We report diaphragm and lung ultrasound findings of a 13-month-old girl affected by SMARD1 (homozygosis c.1540G > A mutation in IGHMPB2 gene) with respiratory failure requiring permanent mechanical ventilation since birth and we discuss the role of diaphragmatic and lung ultrasound in this category of patients and its clinical implications.
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Iovine E, Nenna R, Bloise S, La Regina DP, Pepino D, Petrarca L, Frassanito A, Lubrano R, Midulla F. Lung Ultrasound: Its Findings and New Applications in Neonatology and Pediatric Diseases. Diagnostics (Basel) 2021; 11:652. [PMID: 33916882 PMCID: PMC8066390 DOI: 10.3390/diagnostics11040652] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Lung ultrasound has become increasingly used in both adult and pediatric populations, allowing the rapid evaluation of many lung and pleura diseases. This popularity is due to several advantages of the method such as the low cost, rapidity, lack of ionizing radiation, availability of bedside and repeatability of the method. These features are even more important after the outbreak of the SARS-CoV-2 pandemic, given the possibility of recognizing through ultrasound the signs of interstitial lung syndrome typical of pneumonia caused by the virus. The purpose of this paper is to review the available evidence of lung ultrasound (LUS) in children and its main applications in pediatric diseases.
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Affiliation(s)
- Elio Iovine
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
| | - Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
| | - Silvia Bloise
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, 4100 Latina, Italy; (S.B.); (R.L.)
| | - Domenico Paolo La Regina
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
| | - Daniela Pepino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
| | - Antonella Frassanito
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
| | - Riccardo Lubrano
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, 4100 Latina, Italy; (S.B.); (R.L.)
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy; (E.I.); (D.P.L.R.); (D.P.); (L.P.); (A.F.); (F.M.)
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