Lung Ultrasound is Comparable with Chest Roentgenogram for Diagnosis of Community-Acquired Pneumonia in Hospitalised Children

Abstract

Objective: To evaluate the accuracy of lung ultrasound (LUS) in comparison to chest roentgenogram (CXR) in hospitalised children with community-acquired pneumonia (CAP).

Methods: This study was a hospital based prospective observational study, conducted between January 2014 and December 2014. Hospitalised children aged 2 to 59 mo with community-acquired pneumonia were included in the study. The informed written consent was taken from parents (or legal guardian) before recruitment. Children with suspected or proven asthma, cystic fibrosis, congenital heart disease, immunodeficiency, malignancy and hemodynamic unstability were excluded. CXR, posterio-anterior view, and LUS were done within 24 h of the hospitalisation.

Results: Of 176 consecutively hospitalised cases of CAP, 118 were recruited after screening (65, 55.1% boys; mean age in months ± SD, 26.22 ± 19.60). Abnormal CXR were found in 101 (85.6%) and abnormal LUS in 105 (89%) children. In radiologically proven CAP, LUS was positive in 99/101(98.01%) while among radiologically normal, LUS was abnormal in 6/17 (35.3%). LUS has high sensitivity (98.02%) and reasonable specificity (64.71%) for diagnosing radiologically proven CAP. In diagnosing the specific radiological type of CAP, there was very good concordance (Quadratic Weighted Cohen's Kappa =0.7) between CXR and LUS. Similarly, the authors also found excellent concordance between CXR and LUS (Linear Weighted Cohen's Kappa =0.9) for diagnosis of pleural effusion.

Conclusions: LUS can be considered to be used first before radiography in children with suspected CAP. This will reduce the exposure of radiation.

Keywords: Children; Community-acquired pneumonia; Lung ultrasound; Under-five years; X-ray chest.