A prospective observational study depicting role of lung ultrasound in pediatric pneumonias
Keywords:Bronchopneumonia, Lung ultrasound (LUS), Pediatric, Lobar pneumonia, Chest x-ray
Background: Pneumonia is a major cause of morbidity and mortality in children under five years of age. Chest x-ray poses radiation hazard to children and thus an alternative safe imaging modality must be explored for pediatric pneumonias.
Methods: This prospective observational study included all children below 18 years of age. Majority of patients were below five years of age. All clinically suspicious patients were subjected to chest x-ray and lung ultrasound (LUS). Chest x-ray was considered as imaging diagnostic standard for pneumonia. Consolidation and dynamic air bronchogram were looked on LUS.
Results: A total of 55 patients were included in study with 26 (47.2%) as infants and up to 47 (85.3%) as under five children. Out of 55 cases 32 cases (58.20%) were diagnosed as lobar pneumonia while 23 (41.8%) as bronchopneumonia on chest x-ray. LUS demonstrated high sensitivity and specificity of 90.63% and 100% for lobar pneumonia and 86.96 and 90.63% for bronchopneumonia respectively. Dynamic air bronchogram sign was found in all cases of lobar pneumonia on LUS and with sensitivity of 73.91% in bronchopneumonia.
Conclusions: LUS proved itself as highly sensitive and specific modality for detecting consolidation and owing to safe non ionizing nature of ultrasound, it must be considered as an alternative to chest x-ray as an imaging diagnostic tool for pediatric pneumonia.
Bénet T, Picot VS, Awasthi S, Pandey N, Bavdekar A, Kawade A et al. Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study. Am J Trop Med Hyg. 2017;97(1):68-76.
Liu L, Chu Y, Oza S, Hogan D, Perin J. National, regional, and state-level, all-cause and cause-specific under-5 mortality in India in 2000-15: a systematic analysis with implications for the Sustainable Development Goals. Lancet. 2019;7(6):721-34.
Rudan I, Boschi C, Biloglav Z, Mulholland K, Campbell H. Bulletin of the World Health Organization 2008;86(5):408-16.
Mc Cracken G. Etiology and treatment of pneumonia. Pediatr Infect Dis J. 2000;19(4):373-7.
Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy L, Ziegler T et al. Epidemiology and clinical characteristics of community acquired pneumonia in hospitalized children. Pediatrics. 2004;113(4):701-7.
Tsolia M, Psarras S, Bossios A, Audi H, Paldanius M, Gourgiotis D et al. Etiology of community-acquired pneumonia in hospitalized school-age children: evidence for high prevalence of viral infections. Clin Infect Dis. 2004;39(5):681-6.
Michael O, Donna M, Richard H. Community acquired pneumonia in infants and children. Am Fam Physician. 2004;70(5):899-908.
Ebeledike C, Ahmad T. Pediatric pneumonia. Stat pearls publishing. 2019.
Tajima T, Nakayama E, Kondo Y, Hirai F, Ito H, Iitsuka T, et al. Etiology and clinical study of community-acquired pneumonia in 157 hospitalized children. J Infect Chemother. 2006;12(6):372-9.
Heather J, Mark F. Nosocomial pneumonia in pediatric patients. Pediatric drugs. 2002;4:73-83.
Self WH, Courtney DM, McNaughton C, Wunderink R, Kline J. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013;31(2):401-05.
Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation an exposure. N Engl J Med. 2007;357(22):2277-84.
Mettler FA. Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog. Radiology. 2008;248:254-63.
Taylor T, Meer J, Beck S. Emergency ultrasound lung assessment. Emergency Med J. 2015;47(1):35-6.
Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi Z. The air bronchogram sonographic demonstration. AJR. 1986;147:593-5.
Lichtenstein D, Meziere G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelactasis. Chest. 2009;135(6):1421-5.
Infant mortality rate and under 5 mortality rates. UNICEF Data: Monitoring situation of children and women. 2019.
National and state fact sheets. National family health survey. 2015-2016.
Awasthi S, Pandey C, Mishra N, Verma T. Incidence of community acquired pneumonia in children aged 2-59 months of age in Uttar Pradesh and Bihar, India, in 2016: An indirect estimation. PLoS One. 2019;14(3):e0214086.
Reali F. Sferrazza P, Carlucci P, Fracasso P, Marco D et al. Can Lung Ultrasound Replace Chest Radiography for the Diagnosis of Pneumonia in Hospitalized Children. Respiration. 2014;88(2):112-5.
Balk D, Lee C, Schafer J, Welwarth J, Hardin J et al. Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: A meta-analysis. Pediatr Pulmonol 2018;53(8):1130-39.
Caiulo V, Gargani L, CaiuloS, Fisicaro A, Moramarco F, Latini G et al. Lung ultrasound characteristics of community acquired pneumonia in hospitalized children. Pediatrpulmonol. 2012;48:280-7.
Maria A, Miguel A, Catherine C, Hooper M, Robert H et al. Lung Ultrasound for the Diagnosis of Pneumonia in Children: A Meta-analysis. Pediatrics. 2015;135:(4):714-22.
Bitar Z, Maadarani O, Ajmin M, Shably A. Diagnostic accuracy of chest ultrasound in patients with pneumonia in the intensive care unit: A single‐hospital study. Health Sci Rep. 2018;2;208-12.