Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Feb;56(2):551-560.
doi: 10.1002/ppul.25176. Epub 2020 Nov 26.

Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan

Amy Sarah Ginsburg  1 , Jennifer L Lenahan  2 , Fyezah Jehan  3 , Rubao Bila  4 , Alessandro Lamorte  5 , Jun Hwang  1 , Lola Madrid  6 , Muhammad Imran Nisar  3 , Pio Vitorino  4 , Neel Kanth  7 , Reyes Balcells  6 , Benazir Baloch  3 , Susanne May  1 , Marta Valente  6 , Rosauro Varo  6 , Naila Nadeem  8 , Quique Bassat  4   6   9   10   11 , Giovanni Volpicelli  12
Affiliations
Observational Study

Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan

Amy Sarah Ginsburg et al. Pediatr Pulmonol. 2021 Feb.

Abstract

Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability.

Methods: We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia.

Results: Interrater reliability was excellent for expert LUS interpreters, but poor to moderate for expert CXR interpreters and onsite LUS interpreters with limited training.

Conclusions: Among children with WHO IMCI chest-indrawing pneumonia, expert interpreters may achieve substantially higher interrater reliability for LUS compared to CXR, and LUS showed potential as a preferred reference standard. For point-of-care LUS to be successfully implemented for the diagnosis and management of pneumonia in LRS, the clinical environment and amount of appropriate user training will need to be understood and addressed.

Keywords: chest ultrasound; childhood pneumonia; interrater reliability; low-resource settings.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Flowchart of study participants by country: Mozambique (M), Pakistan (P)
Figure 2
Figure 2
Lung ultrasound examinations consisted of longitudinal and oblique scans obtained of the anterior, lateral, and posterior sides of the child's chest
Figure 3
Figure 3
Graphical representation of a number of children diagnosed with chest‐indrawing pneumonia by World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) criteria, chest radiograph (CXR), and/or lung ultrasound (LUS) in Mozambique and Pakistan
Figure 4
Figure 4
Kappa from this study and previous studies estimating interrater reliability of lung ultrasound (LUS) or chest radiograph (CXR). CXR kappa values from this study are restricted to those estimated using at least 20 children
See this image and copyright information in PMC

References

    1. Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of child mortality in 2000‐13, with projections to inform post‐2015 priorities: an updated systematic analysis. Lancet. 2015;385(9966):430‐440. - PubMed
    1. World Health Organization (WHO) recommendations on child health: guidelines approved by the WHO guidelines review committee. Geneva, Switzerland: WHO; 2017 (WHO/MCA/17.08). License: CC BY‐NC‐SA 3.0 IGO.
    1. Rambaud‐Althaus C, Althaus F, Genton B, D'Acremont V. Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta‐analysis. Lancet Infect Dis. 2015;15(4):439‐450. - PubMed
    1. le Roux DM, Zar HJ. Community‐acquired pneumonia in children—a changing spectrum of disease. Pediatr Radiol. 2017;47(11):1392‐1398. - PMC - PubMed
    1. Mackenzie G. The definition and classification of pneumonia. Pneumonia. 2016;8:14. - PMC - PubMed

Publication types