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. 2022 Jul 21;11(14):4233.
doi: 10.3390/jcm11144233.

Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

Laura Gori  1 , Antonella Amendolea  2 , Danilo Buonsenso  3 , Stefano Salvadori  4 , Maria Chiara Supino  5 , Anna Maria Musolino  5 , Paolo Adamoli  6 , Alfina Domenica Coco  6 , Gian Luca Trobia  7 , Carlotta Biagi  8 , Marco Lucherini  9 , Alberto Leonardi  10 , Giuseppe Limoli  11 , Matteo Giampietri  12 , Tiziana Virginia Sciacca  7 , Rosa Morello  3 , Francesco Tursi  13 , Gino Soldati  14 , Ecobron Group  15   16
Affiliations

Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

Laura Gori et al. J Clin Med. .

Abstract

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.

Keywords: bronchiolitis; children; lung ultrasound; respiratory syncytial virus; ultrasound score.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Division of lung fields for ultrasound scans. Eight pulmonary fields were explored in each ultrasound. For each field longitudinal and transverse scans were made for a total of sixteen ultrasound scans.
Figure 2
Figure 2
Images of the seven types of artifacts. (A) A-lines; (B) Short Vertical Artifacts; (C) Isolated B Lines; (D) Confluent B-Lines; (E) White Lung; (F) Sub-pleural consolidation ≤ 1 cm; (G) Sub-pleural consolidation > 1 cm.
Figure 3
Figure 3
Study flow-chart.
Figure 4
Figure 4
ROC curves comparing qualitative (positive/negative LUS, 4-level LUS including normal, interstitial, consolidative and mixed pattern) and quantitative (mean scores, cutoff score of 9) LUS models. ** ROC curves using the LUS models with the adjunction of the LUS variables “extension” and “early involvement of paravertebral areas”.
Figure 5
Figure 5
Lung Ultrasound (LUS) patterns at baseline and during follow-up. (A) shows changes in number of children with positive LUS; (B) shows changes in type of patterns; (C) shows changes in mean scores; (D) shows number of children with a LUS score higher than 9.
See this image and copyright information in PMC

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