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Yang Y, Wu Y, Zhao W. Comparison of lung ultrasound and chest radiography for detecting pneumonia in children: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:12. [PMID: 38263086 PMCID: PMC10804756 DOI: 10.1186/s13052-024-01583-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Lung ultrasound (LUS) is recommended as a reliable diagnostic alternative to chest X-ray (CXR) for detecting pneumonia in children. METHODS PubMed, Embase, and Cochrane Library databases were used to identify eligible studies from their inception until April 2023. The investigated diagnostic parameters included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC). RESULTS Twenty-six studies involving 3,401 children were selected for meta-analysis. The sensitivity, specificity, PLR, NLR, DOR, and AUC of LUS for detecting pneumonia in children were 0.95, 0.92, 12.31, 0.05, 108.53, and 0.98, respectively, while the sensitivity, specificity, PLR, NLR, DOR, and AUC of CXR were 0.92, 0.93, 24.63, 0.08, 488.54, and 0.99, respectively. The sensitivity of LUS was higher than that of CXR for detecting pneumonia in children (ratio: 1.03; 95% CI: 1.01-1.06; P = 0.018), whereas the DOR of LUS was significantly lower than that of CXR (ratio: 0.22; 95% CI: 0.06-0.85; P = 0.028). CONCLUSIONS This study found that the diagnostic performance of LUS was comparable to that of CXR for detecting pneumonia, and the sensitivity of LUS was superior to that of CXR.
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Affiliation(s)
- Yalong Yang
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China.
| | - Yuexuan Wu
- Department of Pediatrics, General Hospital of Ningxia Medical University, Yinchuan, 750002, China
| | - Wen Zhao
- Ningxia Medical University, Yinchuan, 750004, China
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2
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Jaworska J, Buda N, Kwaśniewicz P, Komorowska-Piotrowska A, Sands D. Lung Ultrasound in the Evaluation of Lung Disease Severity in Children with Clinically Stable Cystic Fibrosis: A Prospective Cross-Sectional Study. J Clin Med 2023; 12:jcm12093086. [PMID: 37176526 PMCID: PMC10179222 DOI: 10.3390/jcm12093086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/15/2023] Open
Abstract
With the increasing longevity of cystic fibrosis (CF), there is a growing need to minimise exposure to ionising radiation in patients who undergo regular imaging tests while monitoring the course of the lung disease. This study aimed to define the role of lung ultrasounds (LUS) in the evaluation of lung disease severity in children with clinically stable CF. LUS was performed on 131 patients aged 5 weeks to 18 years (study group) and in 32 healthy children of an equivalent age range (control group). Additionally, an interobserver study was performed on 38 patients from the study group. In CF patients, the following ultrasound signs were identified: I-lines; Z-lines; single, numerous and confluent B-lines; Am-lines; small and major consolidations; pleural line abnormalities and small amounts of pleural fluid. The obtained results were evaluated against an original ultrasound score. LUS results were correlated with the results of chest X-ray (CXR) [very high], pulmonary function tests (PFTs) [high] and microbiological status [significant]. The interobserver study showed very good agreement between investigators. We conclude that LUS is a useful test in the evaluation of CF lung disease severity compared to routinely used methods. With appropriate standardisation, LUS is highly reproducible.
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Affiliation(s)
- Joanna Jaworska
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Natalia Buda
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, 80-214 Gdansk, Poland
| | - Piotr Kwaśniewicz
- Department of Diagnostic Imaging, Institute of Mother and Child, 01-211 Warsaw, Poland
| | | | - Dorota Sands
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland
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3
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Contemporary Use of Ultrasonography in Acute Care Pediatrics. Indian J Pediatr 2023; 90:459-469. [PMID: 36897471 DOI: 10.1007/s12098-023-04475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/03/2023] [Indexed: 03/11/2023]
Abstract
Use of ultrasonography by clinicians at the point of care has expanded widely and rapidly. Pediatric acute care providers now leverage this valuable tool to guide procedures, diagnose pathophysiologic processes, and inform time-sensitive decisions in sick and unstable children. However, the deployment of any new technology must be packaged with training, protocols, and safeguards to optimize safety for patients, providers, and institutions. As ultrasonography is increasingly incorporated into residency, fellowship, and even medical student curricula, it is important that educators and trainees are aware of the diversity of its clinical applications. This article aims to review the current state of point-of-care ultrasonography in acute care pediatrics, with an emphasis on the literature supporting the use of this important clinical tool.
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4
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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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5
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Kessler D, Dessie A, Kanjanauptom P, Vindas M, Ng L, Youssef MM, Birger R, Shaman J, Dayan P. Lack of Association Between a Quantified Lung Ultrasound Score and Illness Severity in Pediatric Emergency Department Patients With Acute Lower Respiratory Infections. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3013-3022. [PMID: 35620855 DOI: 10.1002/jum.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Lung ultrasound (LUS) may help determine illness severity in children with acute lower respiratory tract infections (LRTI) but limited pediatric studies exist. Our objective was to determine the association between LUS findings and illness severity in children with LRTI. METHODS We conducted a prospective study of patients <20 years with LRTI. Trained investigators performed standardized LUS examinations of 12 regions. Blinded sonologists reviewed examinations for individual pathologic features and also calculated a Quantified Lung Ultrasound Score (QLUS). We defined focal severity as QLUS of ≥2 in ≥1 region, and diffuse severity as QLUS of ≥1 in ≥3 regions. The primary outcome was the Respiratory component of the Pediatric Early Warning Score (RPEWS), a 14-item scale measuring respiratory illness severity. Secondary outcomes included hospital admission, length of stay, supplemental oxygen, and antibiotic use. RESULTS We enrolled 85 patients with LRTIs, 46 (54%) whom were hospitalized (5.4% intensive care). Median RPEWS was 1 (interquartile range 2). Neither individual features on ultrasound nor total QLUS were associated with RPEWS, hospitalization, length of stay, or oxygen use. Mean RPEWS was similar for participants regardless of focal (1.46 versus 1.26, P = .57) or diffuse (1.47 versus 1.21, P = .47) severity findings, but those with focal or diffuse severity, or isolated consolidation, had greater antibiotic administration (P < .001). CONCLUSIONS In children with LRTI, neither individual features nor QLUS were associated with illness severity. Antibiotics were more likely in patients with either focal or diffuse severity or presence of consolidation on ultrasound.
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Affiliation(s)
- David Kessler
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Almaz Dessie
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Panida Kanjanauptom
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marc Vindas
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Lorraine Ng
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
| | - Mariam M Youssef
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Ruthie Birger
- Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Jeff Shaman
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Peter Dayan
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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Rodríguez-Contreras FJ, Calvo-Cebrián A, Díaz-Lázaro J, Cruz-Arnés M, León-Vázquez F, del Carmen Lobón-Agúndez M, Palau-Cuevas FJ, Henares-García P, Gavilán-Martínez F, Fernández-Plaza S, Prieto-Zancudo C. Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study. Ann Fam Med 2022; 20:227-236. [PMID: 35606120 PMCID: PMC9199040 DOI: 10.1370/afm.2796] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/25/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We investigated whether lung ultrasound (US) performed in primary care is useful and feasible for diagnosing community-acquired pneumonia (CAP) compared with chest radiography, as most previous research has been conducted in hospital settings. METHODS We undertook a prospective observational cohort study of lung US performed in 12 primary care centers. Patients aged 5 years and older with symptoms suggesting CAP were examined with lung US (by 21 family physicians and 7 primary care pediatricians) and chest radiograph on the same day. We compared lung US findings with the radiologist's chest radiograph report as the reference standard, given that the latter is the most common imaging test performed for suspected CAP in primary care. The physicians had varied previous US experience, but all received a 5-hour lung US training program. RESULTS The study included 82 patients. Compared with chest radiography, positive lung US findings (consolidation measuring >1 cm or a focal/asymmetrical B-lines pattern) showed a sensitivity of 87.8%, a specificity of 58.5%, a positive likelihood-ratio of 2.12, and a negative likelihood-ratio of 0.21. Findings were similar regardless of the physicians' previous US training or experience. We propose a practical algorithm whereby patients having consolidation measuring greater than 1 cm or normal findings on lung US could skip chest radiography, whereas patients with a B-lines pattern without consolidation (given its low specificity) would need chest radiography to ensure appropriate management. Lung US was generally performed in 10 minutes or less. CONCLUSION Point-of-care lung US in primary care could be useful for investigating suspected CAP (avoiding chest radiography in most cases) and is likely feasible in daily practice, as short training programs appear sufficient and little time is needed to perform the scan.
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Affiliation(s)
| | - Antonio Calvo-Cebrián
- CORRESPONDING AUTHOR Antonio Calvo-Cebrián Centro de Salud Galapagar Avda Víctimas del Terrorismo 3 28260 Galapagar, Madrid, Spain
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7
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Significance of Sonographic Subcentimeter, Subpleural Consolidations in Pediatric Patients Evaluated for Pneumonia. J Pediatr 2022; 243:193-199.e2. [PMID: 34968499 DOI: 10.1016/j.jpeds.2021.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the rates of radiographic pneumonia and clinical outcomes of children with suspected pneumonia and subcentimeter, subpleural consolidations on point-of-care lung ultrasound. STUDY DESIGN We enrolled a prospective convenience sample of children aged 6 months to 18 years undergoing chest radiography (CXR) for pneumonia evaluation in a single tertiary-care pediatric emergency department. Point-of-care lung ultrasound was performed by an emergency medicine physician with subsequent expert review. We determined rates of radiographic pneumonia and clinical outcomes in the children with subcentimeter, subpleural consolidations, stratified by the presence of larger (>1 cm) sonographic consolidations. The children were followed prospectively for 2 weeks to identify a delayed diagnosis of pneumonia. RESULTS A total of 188 patients, with a median age of 5.8 years (IQR, 3.5-11.0 years), were evaluated. Of these patients, 62 (33%) had subcentimeter, subpleural consolidations on lung ultrasound, and 23 (37%) also had larger (>1 cm) consolidations. Patients with subcentimeter, subpleural consolidations and larger consolidations had the highest rates of definite radiographic pneumonia (61%), compared with 21% among children with isolated subcentimeter, subpleural consolidations. Overall, 23 children with isolated subcentimeter, subpleural consolidations (59%) had no evidence of pneumonia on CXR. Among 16 children with isolated subcentimeter, subpleural consolidations and not treated with antibiotics, none had a subsequent pneumonia diagnosis within the 2-week follow-up period. CONCLUSIONS Children with subcentimeter, subpleural consolidations often had radiographic pneumonia; however, this occurred most frequently when subcentimeter, subpleural consolidations were identified in combination with larger consolidations. Isolated subcentimeter, subpleural consolidations in the absence of larger consolidations should not be viewed as synonymous with pneumonia; CXR may provide adjunctive information in these cases.
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8
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Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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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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10
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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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11
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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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12
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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13
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Toro MS, Martínez JLV, Falcão RV, Prata-Barbosa A, Cunha AJLAD. Point-of-care ultrasound by the pediatrician in the diagnosis and follow-up of community-acquired pneumonia. J Pediatr (Rio J) 2021; 97:13-21. [PMID: 32781037 PMCID: PMC9432299 DOI: 10.1016/j.jped.2020.07.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To review, analyze, and present the available evidence on the usefulness of point-of-care pulmonary ultrasound in the diagnosis and monitoring of community-acquired pneumonia (CAP), aiming to facilitate its potential inclusion into pediatric clinical reference guidelines. SOURCE OF DATA A non-systematic research was carried out in the MEDLINE (PubMed), LILACS, and SciELO databases, from January 1985 to September 2019. The articles that were considered the most relevant were selected. SYNTHESIS OF DATA CAP is a relevant cause of morbidity and mortality in pediatrics and its clinical management remains a major challenge. The systematic use of chest X-ray for its diagnosis is controversial because it exposes the child to ionizing radiation and there are interobserver differences in its interpretation. Recently, the use of point-of-care pulmonary ultrasound by the pediatrician has been presented as an alternative for the diagnosis and monitoring of CAP. A great deal of evidence has disclosed its high sensitivity and diagnostic specificity, with the advantages of no ionizing radiation, relatively low cost, immediate results, portability, and the possibility of repetition according to the requirements of disease evolution. Moreover, its use can help rule out possible bacterial etiology and thus prevent inappropriate antibiotic treatments that favor bacterial resistance. CONCLUSIONS Point-of-care ultrasonography represents an opportunity to improve the diagnosis and monitoring of CAP. However, as an operator-dependent technique, training is required for adequate image acquisition, correct interpretation, and integration with clinical data for correct decision-making.
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Affiliation(s)
| | | | - Ricardo Viana Falcão
- Pediatric ICU, Hospital Geral Dr. Waldemar Alcântara (HGWA), Fortaleza, CE, Brazil
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Tusor N, De Cunto A, Basma Y, Klein JL, Meau-Petit V. Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound. Eur J Pediatr 2021; 180:137-146. [PMID: 32592026 PMCID: PMC7317892 DOI: 10.1007/s00431-020-03710-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/29/2020] [Accepted: 05/29/2020] [Indexed: 12/27/2022]
Abstract
No consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known: • Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease. • Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New: • The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease. • LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.
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Affiliation(s)
- Nora Tusor
- Neonatal Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - Angela De Cunto
- Neonatal Intensive Care Unit, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, North Wing 6th floor, Westminster Bridge Road, London, SE1 0EH UK
| | - Yousef Basma
- Neonatal Transfer Service London, Royal London Hospital, Whitechapel Road, London, E1 1FR UK
| | - John L. Klein
- Department of Infectious Diseases, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, North Wing 2nd floor, Westminster Bridge Road, London, SE1 0EH UK
| | - Virginie Meau-Petit
- Neonatal Intensive Care Unit, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, North Wing 6th floor, Westminster Bridge Road, London, SE1 0EH UK
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15
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Henríquez-Camacho C, Miralles-Aguiar F, Bernabeu-Wittel M. Emerging applications of clinical ultrasonography. Rev Clin Esp 2021; 221:45-54. [PMID: 32654759 DOI: 10.1016/j.rce.2020.01.013] [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: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022]
Abstract
In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it).
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Affiliation(s)
- C Henríquez-Camacho
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Madrid, Españan
| | - F Miralles-Aguiar
- Unidad Clínica de Anestesiología y Reanimación, Hospital Universitario Puerta del Mar, Cádiz, España
| | - M Bernabeu-Wittel
- Unidad Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España.
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16
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Yan JH, Yu N, Wang YH, Gao YB, Pan L. Lung ultrasound vs chest radiography in the diagnosis of children pneumonia: Systematic evidence. Medicine (Baltimore) 2020; 99:e23671. [PMID: 33327356 PMCID: PMC7738074 DOI: 10.1097/md.0000000000023671] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this meta-analysis was to evaluate the diagnostic value of lung ultrasound (LUS) in comparison to chest radiography (CXR) in children with pneumonia. METHODS Computer-based retrieval was performed on PubMed and EMBASE. Quality was evaluated according to the quality assessment of diagnostic accuracy studies-2, and Meta-Disc was adopted to perform meta-analysis. Heterogeneity was assessed using Q and I statistics. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence intervals (CIs) as the primary outcomes were calculated for each index test. RESULTS Twenty two studies with a total of 2470 patients met the inclusion criteria. Our results showed that the pooled sensitivity, specificity, and DOR for children with pneumonia diagnosed by LUS were 0.95 (95% CI: 0.94 to 0.96), 0.90 (95% CI: 0.87 to 0.92), and 137.49 (95% CI: 60.21 to 313.98), respectively. The pooled sensitivity, specificity, and DOR for pediatric pneumonia diagnosed by CXR was 0.91 (95% CI: 0.90 to 0.93), 1.00 (95% CI: 0.99 to 1.00), and 369.66 (95% CI: 137.14 to 996.47), respectively. Four clinical signs, including pulmonary consolidation, positive air bronchogram, abnormal pleural line, and pleural effusion were most frequently observed using LUS in the screening of children with pneumonia. CONCLUSIONS The available evidence suggests that LUS is a reliable, valuable, and alternative method to CXR for the diagnosis of pediatric pneumonia.
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Affiliation(s)
- Jun-Hong Yan
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou
- Department of Ultrasound, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei
| | - Na Yu
- Department of Gynecology, Shandong Provincial Third Hospital, Jinan
| | - Yue-Heng Wang
- Department of Ultrasound, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei
| | - Yan-Bing Gao
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
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17
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Giorno EPC, De Paulis M, Sameshima YT, Weerdenburg K, Savoia P, Nanbu DY, Couto TB, Sa FVM, Farhat SCL, Carvalho WB, Preto-Zamperlini M, Schvartsman C. Point-of-care lung ultrasound imaging in pediatric COVID-19. Ultrasound J 2020; 12:50. [PMID: 33252715 PMCID: PMC7702205 DOI: 10.1186/s13089-020-00198-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19. OBJECTIVE To describe lung US imaging findings and aeration score of 34 children with COVID-19. METHODS This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case. RESULTS Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p = 0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US. CONCLUSION Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.
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Affiliation(s)
- Eliana P C Giorno
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil.
| | - Milena De Paulis
- Emergency Department, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil
- Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Kirstin Weerdenburg
- Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Paulo Savoia
- Radiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Radiology Department, Radiology Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Danilo Y Nanbu
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
- Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Thomaz B Couto
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
| | - Fernanda V M Sa
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
- Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Sylvia C L Farhat
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
| | - Werther B Carvalho
- Pediatric Intensive Care, Children's Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcela Preto-Zamperlini
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
| | - Claudio Schvartsman
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
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18
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Henríquez-Camacho C, Miralles-Aguiar F, Bernabeu-Wittel M. Emerging applications of clinical ultrasonography. Rev Clin Esp 2020; 221:45-54. [PMID: 33998478 DOI: 10.1016/j.rceng.2020.01.004] [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: 12/30/2019] [Accepted: 01/16/2020] [Indexed: 10/22/2022]
Abstract
In this work, we introduce the numerous emerging areas and frontiers in the use of point-of-care ultrasonography. Of these, we review the following three: 1) the use of clinical ultrasonography in infectious and tropical diseases (we address its usefulness in the diagnosis and follow-up of the main syndromes, in tropical diseases, and in areas with scarce resources); 2) the usefulness of clinical ultrasonography in the assessment of response to volume infusion in severely ill patients (we review basic concepts and the main static and dynamic variables used for this evaluation); and 3) the use of clinical ultrasonography in the assessment of muscle mass in elderly patients with primary sarcopenia (we review the main muscles and measurements used for it).
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Affiliation(s)
- C Henríquez-Camacho
- Servicio de Medicina Interna, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - F Miralles-Aguiar
- Unidad Clínica de Anestesiología y Reanimación, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M Bernabeu-Wittel
- Unidad Clínica de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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19
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Jaworska J, Komorowska-Piotrowska A, Pomiećko A, Wiśniewski J, Woźniak M, Littwin B, Kryger M, Kwaśniewicz P, Szczyrski J, Kulińska-Szukalska K, Buda N, Doniec Z, Kosiak W. Consensus on the Application of Lung Ultrasound in Pneumonia and Bronchiolitis in Children. Diagnostics (Basel) 2020; 10:diagnostics10110935. [PMID: 33187099 PMCID: PMC7697535 DOI: 10.3390/diagnostics10110935] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022] Open
Abstract
This evidence-based consensus aims to establish the role of point-of-care lung ultrasound in the management of pneumonia and bronchiolitis in paediatric patients. A panel of thirteen experts form five Polish tertiary pediatric centres was involved in the development of this document. The literature search was done in PubMed database. Statements were established based on a review of full-text articles published in English up to December 2019. The development of this consensus was conducted according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluations)-adopted and Delphi method. Initially, 22 proposed statements were debated over 3 rounds of on-line discussion and anonymous voting sessions. A total of 17 statements were agreed upon, including four statements referring to general issues, nine referring to pneumonia and four to bronchiolitis. For five statements experts did not achieve an agreement. The evidence supporting each statement was evaluated to assess the strength of each statement. Overall, eight statements were rated strong, five statements moderate, and four statements weak. For each statement, experts provided their comments based on the literature review and their own experience. This consensus is the first to establish the role of lung ultrasound in the diagnosis and management of pneumonia and bronchiolitis in children as an evidence-based method of imaging.
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Affiliation(s)
- Joanna Jaworska
- Cystic Fibrosis Department, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | | | - Andrzej Pomiećko
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Jakub Wiśniewski
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Mariusz Woźniak
- Department of Pulmonology, Institute of Tuberculosis and Lung Diseases, Regional Branch in Rabka Zdrój, 34-700 Rabka-Zdroj, Poland; (M.W.); (Z.D.)
| | - Błażej Littwin
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Magdalena Kryger
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Piotr Kwaśniewicz
- Department of Diagnostic Imaging, Mother and Child Institute, 01-211 Warsaw, Poland;
| | - Józef Szczyrski
- Clinic of Pediatrics, Hematology and Oncology, University Clinical Center, 80-210 Gdansk, Poland; (A.P.); (J.W.); (B.L.); (J.S.); (M.K.)
| | - Katarzyna Kulińska-Szukalska
- Pediatric Department of Respiratory Tract Disorders, Lung Diseases and Rehabilitation Center, 91-520 Łódź, Poland;
| | - Natalia Buda
- Department and Clinic of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdańsk, 80-210 Gdansk, Poland
- Correspondence:
| | - Zbigniew Doniec
- Department of Pulmonology, Institute of Tuberculosis and Lung Diseases, Regional Branch in Rabka Zdrój, 34-700 Rabka-Zdroj, Poland; (M.W.); (Z.D.)
| | - Wojciech Kosiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
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20
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Cohen SG, Malik ZM, Friedman S, Russell S, Hagbom R, Alazraki A, McCracken CE, Figueroa J, Adisa OA, Mendis RD, Manoranjithan S, Simon HK, Morris CR. Utility of Point-of-Care Lung Ultrasonography for Evaluating Acute Chest Syndrome in Young Patients With Sickle Cell Disease. Ann Emerg Med 2020; 76:S46-S55. [PMID: 32928462 DOI: 10.1016/j.annemergmed.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Acute chest syndrome is a leading cause of mortality in patients with sickle cell disease (SCD). Because early detection of acute chest syndrome is directly tied to prognosis, young patients with SCD undergo countless chest radiography screenings throughout their lifetime for commonly occurring acute chest syndrome risk factors such as fever, chest pain, or cough. Chest radiography is not an ideal screening method because it is associated with radiation exposure, which accumulates with repeated imaging. Point-of-care lung ultrasonography is a nonradiating imaging modality that has been used to identify other lung pathology and may have a role in SCD. The goal of this study was to determine the accuracy of point-of-care lung ultrasound to identify an infiltrate suggestive of acute chest syndrome in patients with SCD compared to chest radiography as the gold standard. METHODS This was a prospective observational study in 2 urban pediatric emergency departments to evaluate the accuracy of point-of-care lung ultrasonography in identifying patients with SCD who were aged 0 to 21 years and had an infiltrate suggestive of acute chest syndrome compared with chest radiography. Clinicians and trainees with point-of-care lung ultrasonographic training obtained informed consent and performed investigational point-of-care lung ultrasonography to evaluate for lung consolidation. A blinded point-of-care lung ultrasonographic expert reviewed results for quality assurance and agreement. Accuracy, sensitivity, specificity, likelihood ratios, and positive and negative predictive value were calculated for point-of-care lung ultrasonography test performance characteristics, with chest radiography as a reference standard. RESULTS Point-of-care lung ultrasonography was performed on 191 SCD patients with a mean age of 8 years; 41% were female patients, and there was a 17% prevalence of acute chest syndrome. Accuracy of point-of-care lung ultrasonography to detected acute chest syndrome was 92%, sensitivity was 88%, and specificity was 93% compared with that for chest radiography. CONCLUSION Point-of-care lung ultrasonography is a feasible alternative to chest radiography for screening for acute chest syndrome in young patients with SCD. Further studies are needed to determine how this test performs within clinical practice.
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Affiliation(s)
- Stephanie G Cohen
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Zayir M Malik
- Division of Emergency Medicine, University of Chicago, Chicago, IL
| | - Sam Friedman
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC
| | - Stephen Russell
- Department of Internal Medicine, Boston Medical Center, Boston, MA
| | | | | | | | - Janet Figueroa
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Reshika D Mendis
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Shaminy Manoranjithan
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Harold K Simon
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
| | - Claudia R Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
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21
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Andrés-Martín A, Escribano Montaner A, Figuerola Mulet J, García García ML, Korta Murua J, Moreno-Pérez D, Rodrigo-Gonzalo de Liria C, Moreno Galdó A. Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP. Arch Bronconeumol 2020; 56:725-741. [PMID: 32534869 DOI: 10.1016/j.arbres.2020.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/28/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.
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Affiliation(s)
- Anselmo Andrés-Martín
- Sección de Neumología Pediátrica, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, España.
| | - Amparo Escribano Montaner
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Joan Figuerola Mulet
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Maria Luz García García
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Universidad Alfonso X El Sabio, Villanueva de la Cañada, Madrid, España
| | - Javier Korta Murua
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Donostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Guipúzcoa, España
| | - David Moreno-Pérez
- Infectología e Inmunodeficiencias, UGC de Pediatría, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Universidad de Málaga, Málaga, España
| | - Carlos Rodrigo-Gonzalo de Liria
- Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | - Antonio Moreno Galdó
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España; CIBER de enfermedades raras, Madrid, España
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22
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Zar HJ, Moore DP, Andronikou S, Argent AC, Avenant T, Cohen C, Green RJ, Itzikowitz G, Jeena P, Masekela R, Nicol MP, Pillay A, Reubenson G, Madhi SA. Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines. Afr J Thorac Crit Care Med 2020; 26:10.7196/AJTCCM.2020.v26i3.104. [PMID: 34471872 PMCID: PMC7433705 DOI: 10.7196/ajtccm.2020.v26i3.104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis. OBJECTIVES To produce revised guidelines for pneumonia in South African children under 5 years of age. METHODS The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision. RECOMMENDATIONS Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided. VALIDATION The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
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Affiliation(s)
- H J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - D P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S Andronikou
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Pediatric Radiology, Perelman School of Medicine, University of Philadephia, USA
| | - A C Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Avenant
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - C Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - R J Green
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Pretoria, South Africa
| | - G Itzikowitz
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
| | - P Jeena
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - M P Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa; and Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - A Pillay
- Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - G Reubenson
- Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - S A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Technology/National Research Foundation: South African Research Chair in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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23
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Buonsenso D, Tomà P, Scateni S, Curatola A, Morello R, Valentini P, Ferro V, D'Andrea ML, Pirozzi N, Musolino AM. Lung ultrasound findings in pediatric community-acquired pneumonia requiring surgical procedures: a two-center prospective study. Pediatr Radiol 2020; 50:1560-1569. [PMID: 32821992 DOI: 10.1007/s00247-020-04750-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lung ultrasound (US) in the evaluation of suspected pediatric pneumonia is increasingly used and has a recognized role in evaluating pleural effusions, although there are no detailed studies specifically addressing its use in the pediatric population. OBJECTIVES To define lung US findings of severe pediatric community-acquired pneumonia that required surgical procedures during admission. MATERIALS AND METHODS Our prospective case-control study compared lung US findings in patients ages 1 month to 17 years admitted with community-acquired pneumonia that required surgical procedures from findings those who did not. Lung US was performed at admission and always before surgical procedures. Medical treatment, laboratory and microbiological findings, chest X-ray, computed tomography scan and surgical procedures are described. RESULTS One hundred twenty-one children with community-acquired pneumonia were included; of these, 23 underwent surgical intervention. Compared with the control group, children requiring a surgical procedure had a significantly higher rate of large consolidations (52.2%; 95% confidence interval [CI]: 30.6% to 73.2%), larger and complicated pleural effusions (100%; 95% CI: 85.2% to 100%), and both liquid and air bronchograms (73.9%; 95% CI: 51.6% to 89.8%). CONCLUSION Larger consolidations, larger and more complicated pleural effusions, and liquid and air bronchograms were associated with surgical treatment.
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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.
- Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paolo Tomà
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simona Scateni
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Antonietta Curatola
- 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
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Valentina Ferro
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Nicola Pirozzi
- Emergency Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
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24
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Tan G, Lian X, Zhu Z, Wang Z, Huang F, Zhang Y, Zhao Y, He S, Wang X, Shen H, Lyu G. Use of Lung Ultrasound to Differentiate Coronavirus Disease 2019 (COVID-19) Pneumonia From Community-Acquired Pneumonia. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2651-2658. [PMID: 32622684 PMCID: PMC7274602 DOI: 10.1016/j.ultrasmedbio.2020.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 05/09/2023]
Abstract
To investigate the feasibility of lung ultrasound in evaluating coronavirus disease 2019 (COVID-19) and distinguish the sonographic features between COVID-19 and community-acquired pneumonia (CAP), a total of 12 COVID-19 patients and 20 CAP patients were selected and underwent lung ultrasound. The modified Buda scoring system for interstitial lung disease was used to evaluate the severity and treatment effect of COVID-19 on ultrasonography. The differences between modified lung ultrasound (MLUS) score and high-resolution computed tomography (HRCT) Warrick score were analyzed to evaluate their correlation. COVID-19 showed the following sonographic features: thickening (12/12), blurred (9/12), discontinuous (6/12) pleural line; rocket sign (4/12), partially diffused B-line (12/12), completely diffused B-line (10/12), waterfall sign (4/12); C-line sign (5/12); pleural effusion (1/12) and pulmonary balloon (Am line, 1/12). The last two features were rarely seen. Differences of ultrasonic features, including lesion range, lung signs and pneumonia-related complications, between COVID-19 and CAP were statistically significant (p˂ 0.05 or 0.001). MLUS scores (p = 0.006) and HRCT Warrick scores (p = 0.015) increased as the severity of COVID-19 increased. The differences between moderate (29.00 [25.75-37.50]) and severe (43.00 [38.75-47.25]) (p = 0.022) or between moderate and critical (47.50 [44.25-50.00]) (p = 0.002) type COVID-19 were statistically significant, compared with those between severe and critical types. Correlation between MLUS scores and HRCT Warrick scores was positive (r = 0.54, p = 0.048). MLUS scores (Z = 2.61, p = 0.009) and HRCT Warrick scores (Z = 2.63, p = 0.009) of five severe or critical COVID-19 patients significantly decreased as their conditions improved after treatment. The differences of sonographic features between COVID-19 and CAP patients were notable. The MLUS scoring system could be used to evaluate the severity and treatment effect of COVID-19.
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Affiliation(s)
- Guoliang Tan
- Department of Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China; Department of Infectious Disease, Wuhan Jinyintan Hospital, Wuhan, China
| | - Xihua Lian
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Fujian, China; Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Zhixing Zhu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Fujian, China; Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Zhenhua Wang
- Department of Cardiovascular Disease, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Fang Huang
- Department of Radiology, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Ying Zhang
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Yanping Zhao
- Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Shaozng He
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Fujian, China; Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Xiali Wang
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Fujian, China
| | - Haolin Shen
- Department of Ultrasound Medicine, Zhangzhou Municipal Hospital, Fujian, China
| | - Guorong Lyu
- Collaborative Innovation Center for Maternal and Infant Health Service Application Technology of Education Ministry, Quanzhou Medical College, Fujian, China; Department of Ultrasound Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China; Department of Ultrasound Medicine, Zhangzhou Municipal Hospital, Fujian, China; Affiliated Hospital of Quanzhou Medical College, Quanzhou, China; Jinjiang Municipal Hospital, Fujian, China.
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25
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Yang Y, Zhang D, Zhou C, Huang H, Wang R. Value of lung ultrasound for the diagnosis of COVID-19 pneumonia: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e039180. [PMID: 32801207 PMCID: PMC7430339 DOI: 10.1136/bmjopen-2020-039180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION In the recent COVID-19 pandemic, cases have exceeded over one million, with the number of confirmed cases increasing by 50 000-60 000 per day. The virus has killed nearly 50 000 people all over the world in only 3 months. These reforms bring major challenges to the public health and healthcare system. The pulmonary pathological features during the initial phase of COVID-19 are alveolar oedema, pneumocyte hyperplasia, gravitational consolidations and interstitial thickening. The ability of lung ultrasound (LUS) and its evolving applications in the diagnosis of COVID-19 pneumonia are widespread. This study aims to evaluate the surveillance value of LUS in the diagnosis of COVID-19 pneumonia. METHODS AND ANALYSIS We will perform a systematic search and meta-analysis on the use of LUS to diagnose and confirm COVID-19 pneumonia. We will search Ovid Medline, Ovid Embase, Web of Science, Cochrane Library, Scopus, Google Scholar, China Biology Medicine disc and WHO Global Health Library for studies on diagnostic accuracy from December 2019 to April 2021. Data collection and screening will be individually accomplished by two reviewers. The assessment of risk of bias for each outcome will be conducted using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Data will be synthesised and heterogeneity will be evaluated. Meta-analysis will be conducted when strong homogeneous data are accessible. Grading of Recommendations Assessment, Development and Evaluation(GRADE) will be used to assess quality of evidence. ETHICS AND DISSEMINATION Approval of ethics committee is not needed for this review. While results will be disseminated electronically, effective dissemination will be done through presentations and peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42020177803; pre-results.
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Affiliation(s)
- Yujiao Yang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Donghang Zhang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
| | - Cheng Zhou
- Lab of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Han Huang
- Department of Anesthesiology, Sichuan University West China Second University Hospital, Chengdu, Sichuan, China
| | - Rurong Wang
- Department of Anesthesiology, Sichuan University West China Hospital, Chengdu, China
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26
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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.
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27
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Paes de Castro Giorno E, Preto-Zamperlini M, Weerdenburg K, de Siqueira Ferraz I, Marques Leite M, Costa Lima Farhat S, Schvartsman C. Point-Of-Care Ultrasound for Lung Assessment in Patients With Severe Scoliosis and Chest Deformities: An Emergency Department Case Series. J Emerg Med 2020; 58:775-780. [PMID: 32247661 DOI: 10.1016/j.jemermed.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/22/2020] [Accepted: 02/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diagnosing pneumonia and other lung conditions can be challenging in patients with severe intellectual or physical disabilities or severe chest deformities. Physical examination is sometimes difficult to perform and the frequently requested chest x-ray (CXR) study is often of little value in the diagnostic approach to this population. Point-of-care lung ultrasound (US) is an emerging diagnostic tool with particularly high level of accuracy in detecting pneumonia, pleural effusion, and pneumothorax. CASE REPORT This case series describes four cases demonstrating the usefulness of point-of-care US in a pediatric emergency department for lung assessment in patients for differentiation and diagnosis of acute causes of acute respiratory symptoms, in whom clinical features or CXR failed to confirm or exclude pulmonary complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with chest deformities, pulmonary complications can be disproportionately frequent. Lung US should be recognized as an important adjunctive tool in this subset of patients to detect pneumonia, pleural effusions, and pneumothorax. When used proactively, it can reduce unnecessary radiation exposure, provide more certainty in determining the diagnosis, and, most importantly, inform correct and timely management.
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Affiliation(s)
| | - Marcela Preto-Zamperlini
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirstin Weerdenburg
- Department of Pediatric Emergency Medicine IWK Health Center and Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Center, Halifax, Nova Scotia, Canada
| | - Isabel de Siqueira Ferraz
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcia Marques Leite
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Sylvia Costa Lima Farhat
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Claudio Schvartsman
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Dean, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, Brazil
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28
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Buonsenso D, Brancato F, Valentini P, Curatola A, Supino M, Musolino AM. The Use of Lung Ultrasound to Monitor the Antibiotic Response of Community-Acquired Pneumonia in Children: A Preliminary Hypothesis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:817-826. [PMID: 31633230 DOI: 10.1002/jum.15147] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
Community-acquired pneumonia (CAP) is associated with high morbidity and mortality among children worldwide. Over the last 10 years, lung ultrasound (US) has been widely studied as an alternative diagnostic tool for adult and pediatric CAP with excellent results. In this case series, we describe clinical and laboratory results as well as detailed lung US findings in 6 children with CAP, showing the potential use of lung US in monitoring the response to antibiotic therapy.
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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
| | - Federica Brancato
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonietta Curatola
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mariachiara Supino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Anna Maria Musolino
- Department of Pediatric Emergency Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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29
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Nadimpalli A, Tsung JW, Sanchez R, Shah S, Zelikova E, Umphrey L, Hurtado N, Gonzalez A, Teicher C. Feasibility of Training Clinical Officers in Point-of-Care Ultrasound for Pediatric Respiratory Diseases in Aweil, South Sudan. Am J Trop Med Hyg 2020; 101:689-695. [PMID: 31287049 PMCID: PMC6726960 DOI: 10.4269/ajtmh.18-0745] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings. Our goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) between COs and experts for lung consolidation with air bronchograms was 0.73 (0.63–0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74–0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.
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Affiliation(s)
| | - James W Tsung
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ramon Sanchez
- Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Sachita Shah
- Department of Emergency Medicine, University of Washington, Seattle, Washington
| | | | - Lisa Umphrey
- Médecins Sans Frontières Medical Department, Sydney, Australia
| | - Northan Hurtado
- Médecins Sans Frontières Medical Department, New York, New York
| | - Alan Gonzalez
- Médecins Sans Frontières Medical Department, New York, New York
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30
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Comprehensive Quantitative Assessment of Lung Liquid Clearance by Lung Ultrasound Score in Neonates with No Lung Disease during the First 24 Hours. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6598348. [PMID: 32185213 PMCID: PMC7060879 DOI: 10.1155/2020/6598348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/06/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
Objectives To comprehensively and quantitatively assess the process of lung liquid clearance using the lung ultrasound score. This study is to evaluate the whole healthy lungs of neonates during the first 24 h. Methods Lung ultrasound was performed in neonates with no respiratory symptoms within 3 h after birth, and scans were then repeated at 6 hours and 24 hours, respectively. The entire chest wall was divided into 12 regions. The lung ultrasound scores of the anterior, posterior, upper, and lower regions and sum of all regions were calculated according to the ultrasound pattern of each region examined. Results The total lung ultrasound score decreased gradually during the first 24 h, with the total lung ultrasound score at 6 h being significantly lower than that at <3 h (P < 0.05). At <3 h, B-lines were more abundant in the posterior chest than in the anterior chest (P < 0.05). At <3 h, B-lines were more abundant in the posterior chest than in the anterior chest (P < 0.05). At <3 h, B-lines were more abundant in the posterior chest than in the anterior chest (. Conclusion Changes in the lung ultrasound score may quantitatively reflect the characteristics of different regions and processes of lung liquid clearance during the first 24 h.
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31
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Scheier E, Zimmerman D. Radiography in the Evaluation of Pediatric Pneumonia. Clin Pediatr (Phila) 2020; 59:216-217. [PMID: 31833398 DOI: 10.1177/0009922819892268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eric Scheier
- Terem Emergency Medical Centers, Jerusalem, Israel
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32
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Guorong LMD, Ying ZMD, Guoliang TMD. Transthoracic Ultrasound Evaluation of Pulmonary Changes in COVID-19 Patients During Treatment Using Modified Protocols. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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33
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Interrater reliability of pediatric point-of-care lung ultrasound findings. Am J Emerg Med 2020; 38:1-6. [DOI: 10.1016/j.ajem.2019.01.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 01/20/2023] Open
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Lung ultrasound in children with pneumonia: interoperator agreement on specific thoracic regions. Eur J Pediatr 2019; 178:1369-1377. [PMID: 31312938 DOI: 10.1007/s00431-019-03428-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/06/2019] [Accepted: 07/08/2019] [Indexed: 02/07/2023]
Abstract
The objective of this study was to evaluate the interoperator agreement of lung ultrasonography (LUS) on specific thoracic regions in children diagnosed with pneumonia and to compare the findings of the LUS with the chest X-ray. Participants admitted to the ward or PICU underwent LUS examinations performed by an expert and a novice operator. A total of 261 thoracic regions in 23 patients were evaluated. Median age and weight of participants were 30 months and 11.6 kg, respectively. A substantial overall agreement between operators was found for normal lung tissue (κ = 0.615, 95% confidence interval (95% CI) = 0.516-0.715) and for consolidations (κ = 0.635, 95% CI = 0.532-0.738). For B-lines, a moderate agreement was observed (κ = 0.573, 95% CI = 0.475-0.671). An almost perfect agreement was found for pleural effusion (κ = 0.868, 95% CI = 0.754-0.982). The diagnosis of consolidations by LUS showed a high sensitivity (93% for both operators) but a low specificity (14% for expert and 25% for novice operator). While intubated patients presented significantly more consolidations, nonintubated patients presented more normal ultrasound patterns.Conclusion: Even when performed by operators with very distinct degrees of experience, LUS had a good interoperator reliability for detecting sonographic patterns on specific thoracic regions. What is Known: • Lung ultrasound is feasible, safe, and highly accurate for the diagnosis of pneumonia in children; however, it does not allow global visualization of the thorax in a single moment as in chest X-rays, and, similar to the stethoscope, partial thorax assessments must be performed sequentially. What is New: • This is the first study evaluating the agreement of LUS on specific thoracic regions between operators with distinct degrees of experience performing the sonograms. • There is a good agreement between an expert operator and a novice operator who underwent a brief theoretical-practical training program on LUS.
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Musolino AM, Tomà P, Supino MC, Scialanga B, Mesturino A, Scateni S, Battaglia M, Pirozzi N, Bock C, Buonsenso D. Lung ultrasound features of children with complicated and noncomplicated community acquired pneumonia: A prospective study. Pediatr Pulmonol 2019; 54:1479-1486. [PMID: 31264383 DOI: 10.1002/ppul.24426] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/06/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to describe lung ultrasound (LUS) findings at baseline and 48 hours after the beginning of treatment and evaluate how they correlate with outcome DESIGN: We prospectively analyzed patients from 1 month to 17 years of age with community acquired pneumonia (CAP) evaluated at a tertiary level pediatric hospital. At baseline and 48 hours after the beginning of treatment, history, clinical examination, laboratory testing, chest X-ray, and LUS were performed. RESULTS One hundred one children were enrolled in the study (13 with complicated CAP). At baseline those who developed complications presented a larger size of the subpleural pulmonary parenchymal lesions (P = .001) often associated with a complex pleural effusion (63.6%, P = .013). Those with an uncomplicated CAP presented an air, arboriform, superficial and dynamic bronchogram, as opposed to complicated CAP which had an air and liquid bronchogram, deep, fixed (P = .001). At the 48-hour control in the noncomplicated CAP group, bronchogram was more frequently superficial and dynamic (P = .050). Pleural effusion disappeared in half cases (P = .050). In all patients, neutrophilic leucocytosis with increased C-reactive protein was detected and decreased at control (P = .001). The linear regression analyses showed the switch from a deep to a superficial bronchogram as the only explanatory variable (r = 0.97, R2 = 0.94, P = .001, t = 10.73). CONCLUSIONS Our study describe early LUS features of CAP that might be able to predict the development of complicated CAP.
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Affiliation(s)
- Anna Maria Musolino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Barbara Scialanga
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessia Mesturino
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Simona Scateni
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Battaglia
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicola Pirozzi
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Caterina Bock
- Department of Radiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Pediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
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Chen AE. Point-of-care lung ultrasonography for pneumonia in children: does size really matter? Arch Dis Child 2019; 104:2-3. [PMID: 29973348 DOI: 10.1136/archdischild-2018-315196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 06/17/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Aaron E Chen
- Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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