Can Lung Ultrasound Act as a Diagnosis and Monitoring Tool in Children with Community Acquired Pneumonia? Correlation with Risk Factors, Clinical Indicators and Biologic Results

Abstract

Background: Community-acquired pneumonia (CAP) is the leading cause of mortality in children from middle- to low-income countries; diagnosing CAP includes clinical evaluation, laboratory testing and pulmonary imaging. Lung ultrasound (LUS) is a sensitive, accessible, non-invasive, non-radiant method for accurately evaluating the lung involvement in acute diseases. Whether LUS findings can be correlated with CAP's severity or sepsis risk remains debatable. This study aimed to increase the importance of LUS in diagnosing and monitoring CAP. We analyzed 102 children aged 1 month up to 18 years, hospital admitted with CAP. Mean age was 5.71 ± 4.85 years. Underweight was encountered in 44.11% of children, especially below 5 years, while overweight was encountered in 11.36% of older children and adolescents. Patients with CAP presented with fever (79.41%), cough (97.05%), tachypnea (18.62%), respiratory failure symptoms (20.58%), chest pain (12.74%) or poor feeding. Despite the fact that 21.56% had clinically occult CAP and six patients (5.88%) experienced radiologically occult pneumonia, CAP diagnosis was established based on anomalies detected using LUS. Conclusions: Detailed clinical examination with abnormal/modified breath sounds and/or tachypnea is suggestive of acute pneumonia. LUS is a sensitive diagnostic tool. A future perspective of including LUS in the diagnosis algorithm of CAP should be taken into consideration.

Keywords: children; community-acquired pneumonia; lung ultrasound.

Figure 1

Study population flow chart selection bias.

Figure 2

Age distribution by sex in the study group. Red—female patients, blue—male patients.

Figure 3

Comparison between the real and ideal weight, based on WHO Child Growth Standards. Mean difference between weight and ideal weight was 1.55 kg (95% CI: −0.47 to 3.57), with a t-statistic of 1.52 and a p-value of 0.131.

Figure 4

Correlation of summed PedPne score at 24 h with a selection of the variables in the dataset (age, weight, PI, BMI, days in the hospital, leucocyte count at 24 h, neutrophil count at 24 h, neutrophil percentage at 24 h, CRP at 24 h and SatO₂ at 24 h), Spearman correlation coefficient (r).

Figure 5

Leucocyte count, neutrophil count, C-reactive protein and summed PedPne comparisons between first and second evaluation.