1
|
Scheier E, Shoseyov D. Pleural line slope in point of care ultrasound assessment of paediatric wheeze may reflect respiratory effort. Acta Paediatr 2024; 113:795-801. [PMID: 38088477 DOI: 10.1111/apa.17057] [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: 09/26/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 03/12/2024]
Abstract
AIM Asthma scoring systems rely on physical examination findings. Point of care ultrasound may provide an objective means to document improvement in the work of breathing in paediatric lower airway obstruction. METHODS Thirty children with wheeze on physical examination (cases) and 15 children presenting with abdominal pain (controls) were studied. Using point-of-care ultrasound, m-mode tracing of lung was recorded above the right hemidiaphragm at the midclavicular line. Pleural line slope and excursion were measured before and after treatment. RESULTS Twenty patients had a final slope measurement under 20°, and only three were admitted-one for hypoxia that resolved prior to ascending to the ward and another for poor compliance. Average decrease in pleural line slope after treatment was 43% and average decrease in pleural line excursion was 32%. Of the 10 children admitted, 8 had measurements over 25°. The correlation coefficient between pleural slope and pleural excursion was 0.67. All controls had a horizontal m-mode tracing at the pleural line. CONCLUSION Oscillation of the m-mode line at the pleura is seen in children with lower airway obstruction and is absent in controls. There appears to be a correlation between beta-agonist therapy and decreased pleural line slope and excursion.
Collapse
Affiliation(s)
- Eric Scheier
- Pediatric Emergency, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shoseyov
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Pulmonology, Kaplan Medical Center, Rehovot, Israel
| |
Collapse
|
2
|
Yang Y, Wu Y, Zhao W. Comparison of lung ultrasound and chest radiography for detecting pneumonia in children: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:12. [PMID: 38263086 PMCID: PMC10804756 DOI: 10.1186/s13052-024-01583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is recommended as a reliable diagnostic alternative to chest X-ray (CXR) for detecting pneumonia in children. METHODS PubMed, Embase, and Cochrane Library databases were used to identify eligible studies from their inception until April 2023. The investigated diagnostic parameters included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC). RESULTS Twenty-six studies involving 3,401 children were selected for meta-analysis. The sensitivity, specificity, PLR, NLR, DOR, and AUC of LUS for detecting pneumonia in children were 0.95, 0.92, 12.31, 0.05, 108.53, and 0.98, respectively, while the sensitivity, specificity, PLR, NLR, DOR, and AUC of CXR were 0.92, 0.93, 24.63, 0.08, 488.54, and 0.99, respectively. The sensitivity of LUS was higher than that of CXR for detecting pneumonia in children (ratio: 1.03; 95% CI: 1.01-1.06; P = 0.018), whereas the DOR of LUS was significantly lower than that of CXR (ratio: 0.22; 95% CI: 0.06-0.85; P = 0.028). CONCLUSIONS This study found that the diagnostic performance of LUS was comparable to that of CXR for detecting pneumonia, and the sensitivity of LUS was superior to that of CXR.
Collapse
Affiliation(s)
- Yalong Yang
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China.
| | - Yuexuan Wu
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China
| | - Wen Zhao
- Ningxia Medical University, Yinchuan, 750004, China
| |
Collapse
|
3
|
Churchill LJ, Tronstad O, Mandrusiak AM, Waldmann JY, Thomas PJ. The role of lung ultrasound for detecting atelectasis, consolidation, and/or pneumonia in the adult cardiac surgery population: A scoping review of the literature. Aust Crit Care 2024; 37:193-201. [PMID: 37709655 DOI: 10.1016/j.aucc.2023.08.002] [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: 03/06/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Postoperative pulmonary complications (PPCs) frequently occur after cardiac surgery and may lead to adverse patient outcomes. Traditional diagnostic tools such as auscultation or chest x-ray have inferior diagnostic accuracy compared to the gold standard (chest computed tomography). Lung ultrasound (LUS) is an emerging area of research combating these issues. However, no review has employed a formal search strategy to examine the role of LUS in identifying the specific PPCs of atelectasis, consolidation, and/or pneumonia or investigated the ability of LUS to predict these complications in this cohort. The objective of this study was to collate and present evidence for the use of LUS in the adult cardiac surgery population to specifically identify atelectasis, consolidation, and/or pneumonia. REVIEW METHOD USED A scoping review of the literature was completed using predefined search terms across six databases which identified 1432 articles. One additional article was included from reviewing reference lists. Six articles met the inclusion criteria, providing sufficient data for the final analysis. DATA SOURCES Six databases were searched: MEDLINE, Embase, CINAHL, Scopus, CENTRAL, and PEDro. This review was not registered. REVIEW METHODS The review followed the PRISMA Extension for Scoping Reviews. RESULTS Several LUS methodologies were reported across studies. Overall, LUS outperformed all other included bedside diagnostic tools, with superior diagnostic accuracy in identifying atelectasis, consolidation, and/or pneumonia. Incidences of PPCs tended to increase with each subsequent timepoint after surgery and were better identified with LUS than all other assessments. A change in diagnosis occurred at a rate of 67% with the inclusion of LUS and transthoracic echocardiography in one study. Pre-established assessment scores were improved by substituting chest x-rays with LUS scans. CONCLUSION The results of this scoping review support the use of LUS as a diagnostic tool after cardiac surgery; however, they also highlighted a lack of consistent methodologies used. Future research is required to determine the optimal methodology for LUS in diagnosing PPCs in this cohort and to determine whether LUS possesses the ability to predict these complications and guide proactive respiratory supports after extubation.
Collapse
Affiliation(s)
- Luke J Churchill
- Physiotherapy Department, The Prince Charles Hospital, Chermside, QLD, 4032, Australia; School of Rehabilitation and Health Sciences, The University of Queensland, QLD, 4072, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Oystein Tronstad
- Physiotherapy Department, The Prince Charles Hospital, Chermside, QLD, 4032, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Allison M Mandrusiak
- School of Rehabilitation and Health Sciences, The University of Queensland, QLD, 4072, Australia.
| | - Jana Y Waldmann
- Library Services, The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - Peter J Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Australia; Department of Intensive Care, Royal Brisbane and Women's Hospital, Herston, Australia.
| |
Collapse
|
4
|
Dong Z, Shen C, Tang J, Wang B, Liao H. Accuracy of Thoracic Ultrasonography for the Diagnosis of Pediatric Pneumonia: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:3457. [PMID: 37998593 PMCID: PMC10670251 DOI: 10.3390/diagnostics13223457] [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: 10/05/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
As an emerging imaging technique, thoracic ultrasonography (TUS) is increasingly utilized in the diagnosis of lung diseases in children and newborns, especially in emergency and critical settings. This systematic review aimed to estimate the diagnostic accuracy of TUS in childhood pneumonia. We searched Embase, PubMed, and Web of Science for studies until July 2023 using both TUS and chest radiography (CR) for the diagnosis of pediatric pneumonia. Two researchers independently screened the literature based on the inclusion and exclusion criteria, collected the results, and assessed the risk of bias using the Diagnostic Accuracy Study Quality Assessment (QUADAS) tool. A total of 26 articles met our inclusion criteria and were included in the final analysis, including 22 prospective studies and four retrospective studies. The StataMP 14.0 software was used for the analysis of the study. The overall pooled sensitivity was 0.95 [95% confidence intervals (CI), 0.92-0.97] and the specificity was 0.94 [95% CI, 0.88-0.97], depicting a good diagnostic accuracy. Our results indicated that TUS was an effective imaging modality for detecting pediatric pneumonia. It is a potential alternative to CXR and a follow-up for pediatric pneumonia due to its simplicity, versatility, low cost, and lack of radiation hazards.
Collapse
Affiliation(s)
- Zhenghao Dong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.D.); (C.S.); (B.W.)
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.D.); (C.S.); (B.W.)
| | - Jinhai Tang
- Department of Radiation Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Beinuo Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.D.); (C.S.); (B.W.)
| | - Hu Liao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.D.); (C.S.); (B.W.)
| |
Collapse
|
5
|
Bessat C, Boillat-Blanco N, Albrich WC. The potential clinical value of pairing procalcitonin and lung ultrasonography to guide antibiotic therapy in patients with community-acquired pneumonia: a narrative review. Expert Rev Respir Med 2023; 17:919-927. [PMID: 37766614 DOI: 10.1080/17476348.2023.2254232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Lower respiratory tract infections (LRTIs) are among the most frequent infections and are prone to inappropriate antibiotic treatments. This results from a limited accuracy of diagnostic tools in identifying bacterial pneumonia. Lung ultrasound (LUS) has excellent sensitivity and specificity in diagnosing pneumonia. Additionally, elevated procalcitonin (PCT) levels correlate with an increased likelihood of bacterial infection. LUS and PCT appear to be complementary in identifying patients with bacterial pneumonia who are likely to benefit from antibiotics. AREAS COVERED This narrative review aims to summarize the current evidence for LUS to diagnose pneumonia, for PCT to guide antibiotic therapy and the clinical value of pairing both tools. EXPERT OPINION LUS has excellent diagnostic accuracy for pneumonia in different settings, regardless of the examiner's experience. PCT guidance safely reduces antibiotic prescription in LRTIs. The combination of both tools has demonstrated an enhanced accuracy in the diagnosis of pneumonia, including CAP in the ED and VAP in the ICU, but randomized controlled studies need to validate the clinical impact of a combined approach.
Collapse
Affiliation(s)
- Cécile Bessat
- Infectious Diseases Service, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Noémie Boillat-Blanco
- Infectious Diseases Service, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases & Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| |
Collapse
|
6
|
Simkovich SM, Hossen S, McCollum ED, Toenjes AK, McCracken JP, Thompson LM, Castañaza A, Diaz A, Rosa G, Kirby MA, Mukeshimana A, Myers R, Lenzen PM, Craik R, Jabbarzadeh S, Elon L, Garg SS, Balakrishnan K, Thangavel G, Peel JL, Clasen TF, Dávila-Román VG, Papageorghiou AT, de Las Fuentes L, Checkley W. Lung Ultrasound Protocol and Quality Control of Image Interpretation Using an Adjudication Panel in the Household Air Pollution Intervention Network (HAPIN) Trial. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1194-1201. [PMID: 36801180 PMCID: PMC10631486 DOI: 10.1016/j.ultrasmedbio.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Lung ultrasound (LUS) is an alternative to chest radiography to confirm a diagnosis of pneumonia. For research and disease surveillance, methods to use LUS to diagnose pneumonia are needed. METHODS In the Household Air Pollution Intervention Network (HAPIN) trial, LUS was used to confirm a clinical diagnosis of severe pneumonia in infants. We developed a standardized definition of pneumonia, protocols for recruitment and training of sonographers, along with LUS image acquisition and interpretation. We use a blinded panel approach to interpretation with LUS cine-loops randomized to non-scanning sonographers with expert review. DISCUSSION We obtained 357 lung ultrasound scans: 159, 8 and 190 scans were collected in Guatemala, Peru and Rwanda, respectively. The diagnosis of primary endpoint pneumonia (PEP) required an expert tie breaker in 181 scans (39%). PEP was diagnosed in 141 scans (40%), not diagnosed in 213 (60%), with 3 scans (<1%) deemed uninterpretable. Agreement among the two blinded sonographers and the expert reader in Guatemala, Peru and Rwanda was 65%, 62% and 67%, with a prevalence-and-bias-corrected kappa of 0.30, 0.24 and 0.33, respectively. CONCLUSION Use of standardized imaging protocols, training and an adjudication panel resulted in high confidence for the diagnosis of pneumonia using LUS.
Collapse
Affiliation(s)
- Suzanne M Simkovich
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Healthcare Delivery, MedStar Health Research Institute, Hyattsville, MD, USA; Division of Pulmonary and Critical Care Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Global Program on Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ashley K Toenjes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - John P McCracken
- Global Health Institute, Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Adly Castañaza
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Anaite Diaz
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ghislaine Rosa
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Miles A Kirby
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Rachel Myers
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Patricia M Lenzen
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Craik
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Shirin Jabbarzadeh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lisa Elon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sarada S Garg
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, India
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Thomas F Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Victor G Dávila-Román
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Lisa de Las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
7
|
Weber MD, Lim JKB, Ginsburg S, Conlon T, Nishisaki A. Translating Guidelines into Practical Practice: Point-of-Care Ultrasound for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:385-406. [PMID: 36898781 DOI: 10.1016/j.ccc.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Point-of-care ultrasound (POCUS) is now transitioning from an emerging technology to a standard of care for critically ill children. POCUS can provide immediate answers to clinical questions impacting management and outcomes within this fragile population. Recently published international guidelines specific to POCUS use in neonatal and pediatric critical care populations now complement previous Society of Critical Care Medicine guidelines. The authors review consensus statements within guidelines, identify important limitations to statements, and provide considerations for the successful implementation of POCUS in the pediatric critical care setting.
Collapse
Affiliation(s)
- Mark D Weber
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Joel K B Lim
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Sarah Ginsburg
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Nti B, Lehmann AS, Haddad A, Kennedy SK, Russell FM. Artificial Intelligence-Augmented Pediatric Lung POCUS: A Pilot Study of Novice Learners. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2965-2972. [PMID: 35429001 PMCID: PMC9790545 DOI: 10.1002/jum.15992] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Respiratory symptoms are among the most common chief complaints of pediatric patients in the emergency department (ED). Point-of-care ultrasound (POCUS) outperforms conventional chest X-ray and is user-dependent, which can be challenging to novice ultrasound (US) users. We introduce a novel concept using artificial intelligence (AI)-enhanced pleural sweep to generate complete panoramic views of the lungs, and then assess its accuracy among novice learners (NLs) to identify pneumonia. METHODS Previously healthy 0- to 17-year-old patients presenting to a pediatric ED with cardiopulmonary chief complaint were recruited. NLs received a 1-hour training on traditional lung POCUS and the AI-assisted software. Two POCUS-trained experts interpreted the images, which served as the criterion standard. Both expert and learner groups were blinded to each other's interpretation, patient data, and outcomes. Kappa was used to determine agreement between POCUS expert interpretations. RESULTS Seven NLs, with limited to no prior POCUS experience, completed examinations on 32 patients. The average patient age was 5.53 years (±1.07). The median scan time of 7 minutes (minimum-maximum 3-43; interquartile 8). Three (8.8%) patients were diagnosed with pneumonia by criterion standard. Sensitivity, specificity, and accuracy for NLs AI-augmented interpretation were 66.7% (confidence interval [CI] 9.4-99.1%), 96.5% (CI 82.2-99.9%), and 93.7% (CI 79.1-99.2%). The average image quality rating was 2.94 (±0.16) out of 5 across all lung fields. Interrater reliability between expert sonographers was high with a kappa coefficient of 0.8. CONCLUSION This study shows that AI-augmented lung US for diagnosing pneumonia has the potential to increase accuracy and efficiency.
Collapse
Affiliation(s)
- Benjamin Nti
- Division of Pediatric Education, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
- Department of Emergency Medicine, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Amalia S. Lehmann
- Division of Pediatric Education, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Aida Haddad
- Division of Pediatric Education, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Sarah K. Kennedy
- Department of Emergency Medicine, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| | - Frances M. Russell
- Department of Emergency Medicine, Department of PediatricsIndiana University School of MedicineIndianapolisINUSA
| |
Collapse
|
11
|
Hypoxia and Polycythemia: A Pediatric Emergency Department Point of Care Ultrasound Diagnosis of Pulmonary Arteriovenous Malformation. Pediatr Emerg Care 2022; 38:633-635. [PMID: 35436766 DOI: 10.1097/pec.0000000000002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Point of care ultrasound (POCUS) can be useful in the differentiation between cardiac and pulmonary etiologies of hypoxia. Here, we present a child with signs of chronic hypoxia, found on POCUS to have multiple pulmonary arteriovenous malformations. A combination of POCUS and history supported a presumptive pediatric emergency department diagnosis of hereditary hemorrhagic telangiectasia. This case is the first case of a pulmonary arteriovenous malformation found on POCUS and reinforces the importance of POCUS as a first-line examination in the evaluation of chronic hypoxia in the pediatric emergency department.
Collapse
|
12
|
Athanasia V, Savvas DP, Soultana F, Marianna SR, Maria A, Katerina K. Neonatal intensive care unit nurse training in identifying ultrasound landmarks in the neonatal mediastinum. Α training program for nurses in North-Eastern Greece. J Pediatr Nurs 2022; 66:e22-e26. [PMID: 35811186 DOI: 10.1016/j.pedn.2022.06.016] [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: 01/29/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To demonstrate methods and landmarks for mediastinum ultrasound as part of ultrasound examination of the lung for nurses. This will be the first step in their education to detect finally the tubes and lines malpositioning in order to distinguish emergency conditions of the lungs in neonates hospitalized in neonatal intensive care units. DESIGN AND METHODS Theoretical and practical interventions were developed to create a 3-month training program based on similar medical courses. The study was approved by the hospital's ethics committee.The program was performed in the neonatal intensive care unit of a single academic institution. Participating nurse was supervised by a paediatric surgeon and trained in lung ultrasound (a safe method without radiation) by a paediatric radiologist. RESULTS During the practical period (2 months), the neonatal intensive care unit nurse examined 50 neonates (25 + 6-40 + 4 weeks gestational age; 21 males) separated into two subgroups of 25 neonates each for each training month. In the first month under supervision, the nurse was trained to recognise the aortic arch, the right pulmonary artery, the esophagus, the tracheal air, and the 'sliding lung sign' in the anterior, lateral, and posterolateral aspects of the thoracic cage. In the second month, the nurse recorded the ultrasound examinations. The identified structures were then assessed and graded by the supervising radiologist. The overall estimated success rate (5 landmarks × 25 neonates = 125) was 90.4%. CONCLUSIONS Although this is the first report of the design of a 'hands-on', lung ultrasound training program for neonatal intensive care unit nurses, our findings demonstrate that it is a safe and useful program for all neonatal intensive care unit nurses because theoverall success rate of the 3-month program was determined by accurate identification of basic anatomical structures (90,4%) by the nurse. PRACTICE IMPLICATIONS This study describes the first educational training program for NICU nurses designed to recognise basic structures in the neonatal mediastinum. If the program is effective, NICU nurses will be able to identify respiratory emergencies. NICU nurses can inform doctors about emergencies according to tubes and lines malpositioning in a timely manner to avoid negative consequences.
Collapse
Affiliation(s)
- Voulgaridou Athanasia
- Neonatal Intensive Care Unit, Alexandroupolis University General Hospital, Alexandroupolis, Greece
| | - Deftereos P Savvas
- Department of Radiology, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Foutzitzi Soultana
- Department of Radiology, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Skordala-Riti Marianna
- Neonatal Intensive Care Unit, Alexandroupolis University General Hospital, Alexandroupolis, Greece
| | - Aggelidou Maria
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kambouri Katerina
- Department of Pediatric Surgery, Alexandroupolis University Hospital, Democritus University of Thrace, Alexandroupolis, Greece.
| |
Collapse
|
13
|
Ma HR, Liu J, Yan WK. Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review. Am J Perinatol 2022; 39:973-979. [PMID: 33242910 DOI: 10.1055/s-0040-1721134] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. STUDY DESIGN We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. RESULTS Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92-1.00) and a specificity of 0.99 (CI: 0.91-1.00). The area under the curve for LUS was 1.00 (0.98-1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. CONCLUSION The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. KEY POINTS · Lung ultrasound is a highly accurate diagnostic tool, which may be a viable and superior alternative to CXR, in diagnosing TTN.. · Lung ultrasound can help differentiate TTN from other etiologies of respiratory distress in neonates.. · There are still some controversies on the ultrasound diagnostic criteria of TTN..
Collapse
Affiliation(s)
- Hai-Ran Ma
- Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou Guangdong, Republic of China
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing and National Neonatal Lung Ultrasound Training Center, Beijing, Republic of China
| | - Jing Liu
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing and National Neonatal Lung Ultrasound Training Center, Beijing, Republic of China
| | - Wen-Kang Yan
- Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou Guangdong, Republic of China
| |
Collapse
|
14
|
Rodríguez-Contreras FJ, Calvo-Cebrián A, Díaz-Lázaro J, Cruz-Arnés M, León-Vázquez F, del Carmen Lobón-Agúndez M, Palau-Cuevas FJ, Henares-García P, Gavilán-Martínez F, Fernández-Plaza S, Prieto-Zancudo C. Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study. Ann Fam Med 2022; 20:227-236. [PMID: 35606120 PMCID: PMC9199040 DOI: 10.1370/afm.2796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated whether lung ultrasound (US) performed in primary care is useful and feasible for diagnosing community-acquired pneumonia (CAP) compared with chest radiography, as most previous research has been conducted in hospital settings. METHODS We undertook a prospective observational cohort study of lung US performed in 12 primary care centers. Patients aged 5 years and older with symptoms suggesting CAP were examined with lung US (by 21 family physicians and 7 primary care pediatricians) and chest radiograph on the same day. We compared lung US findings with the radiologist's chest radiograph report as the reference standard, given that the latter is the most common imaging test performed for suspected CAP in primary care. The physicians had varied previous US experience, but all received a 5-hour lung US training program. RESULTS The study included 82 patients. Compared with chest radiography, positive lung US findings (consolidation measuring >1 cm or a focal/asymmetrical B-lines pattern) showed a sensitivity of 87.8%, a specificity of 58.5%, a positive likelihood-ratio of 2.12, and a negative likelihood-ratio of 0.21. Findings were similar regardless of the physicians' previous US training or experience. We propose a practical algorithm whereby patients having consolidation measuring greater than 1 cm or normal findings on lung US could skip chest radiography, whereas patients with a B-lines pattern without consolidation (given its low specificity) would need chest radiography to ensure appropriate management. Lung US was generally performed in 10 minutes or less. CONCLUSION Point-of-care lung US in primary care could be useful for investigating suspected CAP (avoiding chest radiography in most cases) and is likely feasible in daily practice, as short training programs appear sufficient and little time is needed to perform the scan.
Collapse
Affiliation(s)
| | - Antonio Calvo-Cebrián
- CORRESPONDING AUTHOR Antonio Calvo-Cebrián Centro de Salud Galapagar Avda Víctimas del Terrorismo 3 28260 Galapagar, Madrid, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Lu X, Jin Y, Li Y, Weng L, Li H. Diagnostic accuracy of lung ultrasonography in childhood pneumonia: a meta-analysis. Eur J Emerg Med 2022; 29:105-117. [PMID: 34619690 DOI: 10.1097/mej.0000000000000883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This meta-analysis aimed to assess the diagnostic accuracy of lung ultrasonography in pneumonia-affected pediatric patients. Literature search of published articles in Medline, Web of Science, Scopus, Embase and Journal of Web till September 2020 were reviewed for the predescribed accuracy assessors. In compliance with the inclusion and exclusion criteria, two researchers independently screened the literature, collected the results and assessed the risks of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The pooled sensitivity and specificity, pooled positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were estimated for the meta-analysis. The overall efficiency of lung ultrasonography (LUS) was evaluated using a summary receiver operating characteristic curve. Q and I2 statistics were used to determine heterogeneity. Meta disc software was used for the analysis of the study. Out of 1182 studies, only 29 articles were chosen; 25 of them were prospective studies and 4 studies were retrospective. The overall pooled sensitivity was 0.83 [95% confidence intervals (CI), 0.81-0.84] and specificity was 0.84 (95% CI, 0.81-0.86), depicting good diagnostic performance. LUS is an efficient imaging technique for detecting childhood pneumonia with a high accuracy rate. It is an appealing alternative to chest X rays to detect and follow-up pneumonia in children because it is simple to do, widely available, comparatively cheap and free of radiation hazards.
Collapse
Affiliation(s)
- Xiaoxue Lu
- Department of Functional Division, The Seventh People's Hospital of Zhengzhou, Henan, Zhengzhou
| | - Yanping Jin
- Department of Ultrasound, Ezhou Central Hospital, Ezhou City, Hubei Province
| | - Ying Li
- Department of Radiology, Langfang City People's Hospital, Langfang, Hebei
| | - Liang Weng
- Department of Ultrasound Diagnosis, 900 Hospital of the Joint Logistics Team, Fuzhou
| | - Hui Li
- Department of Pediatrics, Chongqing Qijiang District People's Hospital, China
| |
Collapse
|
16
|
Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
Collapse
Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
17
|
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.
Collapse
|
18
|
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.
Collapse
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.)
| |
Collapse
|
19
|
Ammirabile A, Buonsenso D, Di Mauro A. Lung Ultrasound in Pediatrics and Neonatology: An Update. Healthcare (Basel) 2021; 9:1015. [PMID: 34442152 PMCID: PMC8391473 DOI: 10.3390/healthcare9081015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022] Open
Abstract
The potential role of ultrasound for the diagnosis of pulmonary diseases is a recent field of research, because, traditionally, lungs have been considered unsuitable for ultrasonography for the high presence of air and thoracic cage that prevent a clear evaluation of the organ. The peculiar anatomy of the pediatric chest favors the use of lung ultrasound (LUS) for the diagnosis of respiratory conditions through the interpretation of artefacts generated at the pleural surface, correlating them to disease-specific patterns. Recent studies demonstrate that LUS can be a valid alternative to chest X-rays for the diagnosis of pulmonary diseases, especially in children to avoid excessive exposure to ionizing radiations. This review focuses on the description of normal and abnormal findings during LUS of the most common pediatric pathologies. Current literature demonstrates usefulness of LUS that may become a fundamental tool for the whole spectrum of lung pathologies to guide both diagnostic and therapeutic decisions.
Collapse
Affiliation(s)
- Angela Ammirabile
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, “Aldo Moro” University of Bari, 70100 Bari, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Via Conversa 12, 10135 Margherita di Savoia, Italy;
| |
Collapse
|
20
|
House DR, Amatya Y, Nti B, Russell FM. Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting. Ultrasound J 2021; 13:34. [PMID: 34191145 PMCID: PMC8245620 DOI: 10.1186/s13089-021-00236-4] [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: 03/17/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea. METHODS A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training. RESULTS Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively. CONCLUSIONS Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.
Collapse
Affiliation(s)
- Darlene R House
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal.
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Yogendra Amatya
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Benjamin Nti
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN, 46202, USA
| | - Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, Indianapolis, IN, 46202, USA
| |
Collapse
|
21
|
Kameda T, Mizuma Y, Taniguchi H, Fujita M, Taniguchi N. Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era. J Med Ultrason (2001) 2021; 48:31-43. [PMID: 33438132 PMCID: PMC7803468 DOI: 10.1007/s10396-020-01074-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022]
Abstract
In the coronavirus disease-2019 (COVID-19) era, point-of-care lung ultrasound (LUS) has attracted increased attention. Prospective studies on LUS for the assessment of pneumonia in adult patients were extensively carried out for more than 10 years before this era. None of these prospective studies attempted to differentiate bacterial and viral pneumonia in adult patients using LUS. The majority of studies considered the LUS examination to be positive if sonographic consolidations or multiple B-lines were observed. Significant differences existed in the accuracy of these studies. Some studies revealed that LUS showed superior sensitivity to chest X-ray. These results indicate that point-of-care LUS has the potential to be an initial imaging modality for the diagnosis of pneumonia. The LUS diagnosis of ventilator-associated pneumonia in intensive care units is more challenging in comparison with the diagnosis of community-acquired pneumonia in emergency departments due to the limited access to the mechanically ventilated patients and the high prevalence of atelectasis. However, several studies have demonstrated that the combination of LUS findings with other clinical markers improved the diagnostic accuracy. In the COVID-19 era, many case reports and small observational studies on COVID-19 pneumonia have been published in a short period. Multiple B-lines were the most common and consistent finding in COVID-19 pneumonia. Serial LUS showed the deterioration of the disease. The knowledge and ideas on the application of LUS in the management of pneumonia that are expected to accumulate in the COVID-19 era may provide us with clues regarding more appropriate management.
Collapse
Affiliation(s)
- Toru Kameda
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. .,Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino-shi, Nagano, 399-8293, Japan.
| | - Yoshihiro Mizuma
- Department of Internal Medicine, Higashi Kobe Hospital, 1-24-13 Sumiyoshihonmachi, Higashinada-ku, Kobe-shi, Hyogo, 658-0051, Japan
| | - Hayato Taniguchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama-shi, Kanagawa, 232-0044, Japan
| | - Masato Fujita
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino-shi, Nagano, 399-8293, Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| |
Collapse
|
22
|
Gillon JT, Gorn M, Wilkinson M. Comparison of ultrasound-guided versus fluoroscopy-guided reduction of forearm fractures in children. Emerg Radiol 2020; 28:303-307. [PMID: 33030662 DOI: 10.1007/s10140-020-01862-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) can be used to guide and assess reduction of pediatric forearm fractures. In this study, we sought to compare the success rate of ultrasound-guided fracture reduction with fluoroscopy-guided fracture reduction. We also sought to determine whether there are cost or time benefits to using ultrasound instead of fluoroscopy. METHODS The electronic medical records of patients less than 18 years of age presenting to a pediatric emergency department with a forearm fracture between April 2016 and March 2019 were screened for inclusion in this study. A total of 27 ultrasound-guided reductions were identified during this time period and 81 fluoroscopy-guided reductions were randomly selected for comparison. Cost data was provided by the financial department. Reduction success, total length of stay, and costs were compared between the two groups, and multiple linear regression was used to determine the influence of any confounding predictor variables. RESULTS There were no failed reductions in either group. Length of stay was shorter in the POCUS group (221 min) compared with the fluoroscopy group (254 min, p = 0.014), but this significance was lost in the regression model when adjusted for ketamine use. Provider costs ($430 v $442, p = 0.822) and total costs ($1219 v $1204, p = 0.851) were the same between the POCUS group and the fluoroscopy group, respectively. CONCLUSION POCUS appears to be an equally effective imaging modality to guide reduction of forearm fractures as compared to fluoroscopy.
Collapse
Affiliation(s)
- Jason T Gillon
- Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Michael Gorn
- Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Matthew Wilkinson
- Division of Pediatric Emergency Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| |
Collapse
|
23
|
Could It Be Pneumonia? Lung Ultrasound in Children With Low Clinical Suspicion for Pneumonia. Pediatr Qual Saf 2020; 5:e326. [PMID: 32766497 PMCID: PMC7360217 DOI: 10.1097/pq9.0000000000000326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/13/2020] [Indexed: 01/09/2023] Open
Abstract
Supplemental Digital Content is available in the text. Background: Community-acquired pneumonia (CAP) is a significant cause of pediatric morbidity and mortality worldwide. Emergency department point of care ultrasound (POCUS) is a first-line modality for diagnosis of CAP. The current coronavirus disease 2019 pandemic creates a unique opportunity to incorporate lung POCUS into the evaluation of a broader range of children. It has increased the utility of lung POCUS in both evaluation and follow-up of pediatric coronavirus cases. An increased use of lung POCUS creates an opportunity for earlier diagnosis while allowing the opportunity for overdiagnosis of small infiltrates and atelectasis. We collated a case series to demonstrate the benefit of lung POCUS in a very broad range of children. Methods: We collected a case series of 5 patients between December 2018 and December 2019 who presented nonclassically and were diagnosed with CAP on POCUS by a pediatric emergency physician. Conclusion: Routine lung POCUS in ill children will allow treating physicians to identify and follow a pulmonary infiltrate consistent with CAP quickly. We anticipate that early and more frequent use of POCUS and earlier diagnosis of CAP may improve outcomes by decreasing healthcare encounters within the same illness and by reducing the incidence of late sequelae of pneumonia such as empyema and effusions. However, we acknowledge that this may come at the expense of the overtreatment of viral infiltrates and atelectasis. Further study is required to improve the specificity of lung POCUS in the evaluation of CAP.
Collapse
|
24
|
Tsou PY, Rafael J, Ma YK, Wang YH, Raj S, Encalada S, Deanehan JK. Diagnostic accuracy of procalcitonin for bacterial pneumonia in children - a systematic review and meta-analysis. Infect Dis (Lond) 2020; 52:683-697. [PMID: 32615062 DOI: 10.1080/23744235.2020.1788719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: The predictive role of procalcitonin for childhood bacterial pneumonia, a leading cause of death, is unclear. We aimed to evaluate the diagnostic accuracy of procalcitonin for childhood bacterial pneumonia.Methods: Major bibliographic databases were searched from inception through September 2019 using pre-defined index terms, including 'procalcitonin,' 'pneumonia' and 'children'. The study is reported according to Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. Meta-analyses of the diagnostic accuracy and odds ratio of procalcitonin for bacterial pneumonia were conducted along with subgroup analyses for different cut-offs of procalcitonin. The Quality Assessment of Diagnostic Accuracy Studies 2 instrument was used to assess the methodologic quality of eligible studies.Results: Twenty-five studies (with 2,864 patients) showed that procalcitonin for bacterial pneumonia had an overall sensitivity of 0.64 (95% confidence interval: 0.53-0.74), specificity of 0.72 (95% confidence interval: 0.64-0.79), positive likelihood ratio of 2.3 (95% confidence interval: 1.8-3.0) and negative likelihood ratio of 0.50 (95% confidence interval: 0.38-0.66), and Area Under the Receiver Operating Characteristics of 0.74 (95% confidence interval: 0.70-0.78). Using a cut-off of 0.5 ng/ml, Procalcitonin had a sensitivity of 0.68 (95% confidence interval: 0.50-0.82), specificity of 0.60 (95% confidence interval: 0.47-0.72), and Area Under the Receiver Operating Characteristics of 0.68 (95% confidence interval: 0.64-0.72). Using a cut-off of 2 ng/ml, procalcitonin had a sensitivity of 0.59 (95% confidence interval: 0.40-0.76), specificity of 0.71 (95% confidence interval: 0.58-0.81), and AUROC curve of 0.71 (95% confidence interval: 0.67-0.75). Elevated procalcitonin was not associated with increased odds of bacterial pneumonia (odds ratio: 1.36, 95% confidence interval: 0.81-1.92, p = .18). Quality assessment found minimal concerns for bias or applicability.Conclusions: Given the moderate diagnostic accuracy of procalcitonin for bacterial pneumonia, we recommend that procalcitonin be used in conjunction with other findings for management and disposition of children with pneumonia.
Collapse
Affiliation(s)
- Po-Yang Tsou
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Rafael
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Yu-Kun Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Hsun Wang
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shekhar Raj
- Department of Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Santiago Encalada
- Department of Pulmonary Medicine, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Julia K Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
25
|
Strøm JJ, Haugen PS, Hansen MP, Graumann O, Jensen MBB, Aakjær Andersen C. Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review. BMJ Open 2020; 10:e036067. [PMID: 32554727 PMCID: PMC7304808 DOI: 10.1136/bmjopen-2019-036067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We aimed to systematically review the published literature regarding adults with clinical suspicion of pneumonia that compares the accuracy of lung ultrasonography (LUS) performed by non-imaging specialists to other reference standards in diagnosing and evaluating the severity of community-acquired pneumonia. Moreover, we aimed to describe LUS training and the speciality of the physician performing LUS, time spent on the LUS procedure and potential harms to patients. MATERIALS AND METHODS We searched MEDLINE, Embase, CINAHL, Web of Science and Cochrane Central Register of Controlled Trials up until May 2019. We included studies that used LUS to diagnose pneumonia, but also confirmed pneumonia by other means. Publications were excluded if LUS was performed by a sonographer or radiologist (imaging specialists) or performed on other indications than suspicion of pneumonia. Two review authors screened and selected articles, extracted data and assessed quality using Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS We included 17 studies. The sensitivity of LUS to diagnose pneumonia ranged from 0.68 to 1.00; however, in 14 studies, sensitivity was ≥0.91. Specificities varied from 0.57 to 1.00. We found no obvious differences between studies with low and high diagnostic accuracy. The non-imaging specialists were emergency physicians, internal medicine physicians, intensivists or 'speciality not described'. Five studies described LUS training, which varied from a 1-hour course to fully credentialed ultrasound education. In general, the methodological quality of studies was good, though, some studies had a high risk of bias. CONCLUSION We found significant heterogeneity across studies. In the majority of studies, LUS in the hands of the non-imaging specialists demonstrated high sensitivities and specificities in diagnosing pneumonia. However, due to problems with methodology and heterogeneity there is a need for larger studies with uniform and clearly established criteria for diagnosis and blinding. PROSPERO REGISTRATION NUMBER Prospectively registered in PROSPERO (CRD42017057804).
Collapse
Affiliation(s)
| | | | | | - Ole Graumann
- Department of Radiology, Odense Universitetshospital, Odense, Denmark
- Institute for Clinical Research, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
| | | | | |
Collapse
|
26
|
Prager R, Bowdridge J, Kareemi H, Wright C, McGrath TA, McInnes MDF. Adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 Guidelines in Acute Point-of-Care Ultrasound Research. JAMA Netw Open 2020; 3:e203871. [PMID: 32356885 PMCID: PMC7195624 DOI: 10.1001/jamanetworkopen.2020.3871] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Incomplete reporting of diagnostic accuracy research impairs assessment of risk of bias and limits generalizability. Point-of-care ultrasound has become an important diagnostic tool for acute care physicians, but studies assessing its use are of varying methodological quality. OBJECTIVE To assess adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 guidelines in the literature on acute care point-of-care ultrasound. EVIDENCE REVIEW MEDLINE was searched to identify diagnostic accuracy studies assessing point-of-care ultrasound published in critical care, emergency medicine, or anesthesia journals from 2016 to 2019. Studies were evaluated for adherence to the STARD 2015 guidelines, with the following variables analyzed: journal, country, STARD citation, STARD-adopting journal, impact factor, patient population, use of supplemental material, and body region. Data analysis was performed in November 2019. FINDINGS Seventy-four studies were included in this systematic review for assessment. Overall adherence to STARD was moderate, with 66% (mean [SD], 19.7 [2.9] of 30 items) of STARD items reported. Items pertaining to imaging specifications, patient population, and readers of the index test were frequently reported (>66% of studies). Items pertaining to blinding of readers to clinical data and to the index or reference standard, analysis of heterogeneity, indeterminate and missing data, and time intervals between index and reference test were either moderately (33%-66%) or infrequently (<33%) reported. Studies in STARD-adopting journals (mean [SD], 20.5 [2.9] items in adopting journals vs 18.6 [2.3] items in nonadopting journals; P = .002) and studies citing STARD (mean [SD], 21.3 [0.9] items in citing studies vs 19.5 [2.9] items in nonciting studies; P = .01) reported more items. Variation by country and journal of publication were identified. No differences in STARD adherence were identified by body region imaged (mean [SD], abdominal, 20.0 [2.5] items; head and neck, 17.8 [1.6] items; musculoskeletal, 19.2 [3.1] items; thoracic, 20.2 [2.8] items; and other or procedural, 19.8 [2.7] items; P = .29), study design (mean [SD], prospective, 19.7 [2.9] items; retrospective, 19.7 [1.8] items; P > .99), patient population (mean [SD], pediatric, 20.0 [3.1] items; adult, 20.2 [2.7] items; mixed, 17.9 [1.9] items; P = .09), use of supplementary materials (mean [SD], yes, 19.2 [3.0] items; no, 19.7 [2.8] items; P = .91), or journal impact factor (mean [SD], higher impact factor, 20.3 [3.1] items; lower impact factor, 19.1 [2.4] items; P = .08). CONCLUSIONS AND RELEVANCE Overall, the literature on acute care point-of-care ultrasound showed moderate adherence to the STARD 2015 guidelines, with more complete reporting found in studies citing STARD and those published in STARD-adopting journals. This study has established a current baseline for reporting; however, future studies are required to understand barriers to complete reporting and to develop strategies to mitigate them.
Collapse
Affiliation(s)
- Ross Prager
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Bowdridge
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hashim Kareemi
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Chris Wright
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Trevor A. McGrath
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew D. F. McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
27
|
Corcoran JP, Laursen CB. Response. Chest 2020; 157:742-743. [DOI: 10.1016/j.chest.2019.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 10/24/2022] Open
|
28
|
Bellman LA, Liu YT. Lung Ultrasound for Diagnosis of Pneumonia in Children. Acad Emerg Med 2020; 27:245-246. [DOI: 10.1111/acem.13920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/10/2020] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Lilly A. Bellman
- Department of Emergency Medicine Harbor‐UCLA Medical Center Torrance CA
| | - Yiju T. Liu
- Department of Emergency Medicine Harbor‐UCLA Medical Center Torrance CA
| |
Collapse
|
29
|
Wang D, Zhang J, Sun Y, Lv N, Sun J. Long non-coding RNA NKILA weakens TNF-α-induced inflammation of MRC-5 cells by miR-21 up-regulation. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2020; 48:498-505. [PMID: 32013579 DOI: 10.1080/21691401.2020.1716781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Dandan Wang
- Department of Pediatrics, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jiajie Zhang
- Department of Pediatrics, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yan Sun
- Department of Pediatrics, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Nan Lv
- Department of Pediatrics, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Jianwei Sun
- Department of Pediatrics, Henan Provincial People’s Hospital, Zhengzhou, China
| |
Collapse
|