Lung Ultrasound is Comparable with Chest Roentgenogram for Diagnosis of Community-Acquired Pneumonia in Hospitalised Children.
TL;DR: LUS can be considered to be used first before radiography in children with suspected CAP to reduce the exposure of radiation.
Abstract: To evaluate the accuracy of lung ultrasound (LUS) in comparison to chest roentgenogram (CXR) in hospitalised children with community-acquired pneumonia (CAP). 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. 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. LUS can be considered to be used first before radiography in children with suspected CAP. This will reduce the exposure of radiation.
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TL;DR: The primary objective of this meta‐analysis is to evaluate the accuracy of lung ultrasound (LUS) compared to CXR for the diagnosis of pCAP.
Abstract: OBJECTIVE Although a clinical diagnosis, the standard initial imaging modality for patients with concern for pediatric community acquired pneumonia (pCAP) is a chest x-ray (CXR), which has a relatively high false negative rate, exposes patients to ionizing radiation, and may not be available in resource limited settings. The primary objective of this meta-analysis is to evaluate the accuracy of lung ultrasound (LUS) compared to CXR for the diagnosis of pCAP. METHODS Data were collected via a systematic review of PubMed, EMBASE, and Web of Science with dates up to August 2017. Keywords and search terms were generated for pneumonia, lung ultrasound, and pediatric population. Two independent investigators screened abstracts for inclusion. PRISMA was used for selecting appropriate studies. QUADAS was applied to these studies to assess quality for inclusion into the meta-analysis. We collected data from included studies and calculated sensitivity, specificity, positive predictive value, and negative predictive values of CXR and LUS for the diagnosis of pCAP. RESULTS Twelve studies including 1510 patients were selected for data extraction. LUS had a sensitivity of 95.5% (93.6-97.1) and specificity of 95.3% (91.1-98.3). CXR had a sensitivity of 86.8% (83.3-90.0) and specificity of 98.2% (95.7-99.6). Variations between the studies included ultrasound findings diagnostic of pneumonia, study setting (inpatient vs emergency department) and inclusion of CXR in the reference standard for pneumonia. CONCLUSIONS In our meta-analysis, lung ultrasound had significantly better sensitivity with similar specificity when compared to chest x-ray for the diagnosis of pediatric community acquired pneumonia.
80 citations
Cites background or methods from "Lung Ultrasound is Comparable with ..."
...radiologist sonographers following 4 h of LUS training and performance of 15 LUS exams.(36) One study evaluated both expert and novice pediatric emergency medicine sonographers, with novice being defined as fewer than 25 LUS exams....
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...However, two of the studies included novice sonographers, defined as having fewer than 25 thoracic ultrasounds in one study(21) and 4 h of training with only 15 thoracic ultrasounds in the other.(36) In the Shah et al study,(21) this novice group was slightly less accurate with a total of four errors out of a total 131 LUS exams, but still more accurate than CXR read by an expert radiologist....
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TL;DR: The current and emerging use of diagnostic POCUS by noncardiology and nonradiology clinicians in the care of pediatric patients and efforts to build standardized POC US infrastructure within specialties and institutions are described.
Abstract: Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.
65 citations
TL;DR: LUS seems to be a promise tool for diagnosing pneumonia in children, however, the high heterogeneity found across the individual studies, and the absence of a reliable reference standard, make the finding questionable.
53 citations
TL;DR: LUS can accurately diagnose pneumonia in children, however, this test demonstrates operator-dependent variability, with more experienced sonographers having higher diagnostic accuracy.
Abstract: BACKGROUND Childhood pneumonia is a leading cause of mortality worldwide. Growing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic alternative to chest x-ray for childhood pneumonia. However, it is unclear whether sonographer experience affects the diagnostic accuracy of LUS. We summarize the diagnostic accuracy of LUS for pneumonia and compare the performance between novice and advanced sonographers with a systematic review and meta-analysis. METHODS We searched PubMed and EMBASE from inception to February 2018 for eligible studies that evaluated the utility of LUS in children suspected of having pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory, and imaging results. We reported the study using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. We used QUADAS-2 to appraise the included studies' methodologic quality. We employed a random-effect bivariate model and a hierarchical summary receiver operating characteristic curve to evaluate LUS's performance characteristics. We conducted subgroup analyses and meta-regression based on level of sonographer training to summarize and compare LUS's diagnostic accuracy for pneumonia between novice (training ≤ 7 days) and advanced sonographers. RESULTS Twenty-five studies (n = 3,353) were included in the meta-analysis. For diagnosing pneumonia, LUS demonstrated an overall sensitivity of 0.94 (95% confidence interval [CI] = 0.89 to 0.97), specificity of 0.92 (95% CI = 0.78 to 0.98), positive likelihood ratio of 12.40 (95% CI = 4.00 to 38.10), and negative likelihood ratio of 0.07 (95% CI = 0.04 to 0.12), with an area under ROC curve of 0.97 (95% CI = 0.95 to 0.98). Meta-regression revealed a significant difference in the diagnostic accuracy for pneumonia for LUS between novice and advanced sonographers (p < 0.01). CONCLUSION LUS can accurately diagnose pneumonia in children. However, this test demonstrates operator-dependent variability, with more experienced sonographers having higher diagnostic accuracy. Further work on evidence-based educational methods to train novice sonographers in LUS is required.
30 citations
TL;DR: A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience and involves no significant knowledge of anatomy or technical skill.
Abstract: Objective Pneumonia is the leading cause of pediatric mortality worldwide among children 0-5 years old. Lung ultrasound can be used to diagnose pneumonia in rural areas as it is a portable and relatively economic imaging modality with ~95% sensitivity and specificity for pneumonia in children. Lack of trained sonographers is the current limiting factor to its deployment in rural areas. In this study, we piloted training of a volume sweep imaging (VSI) ultrasound protocol for pneumonia detection in Peru with rural health workers. VSI may be taught to individuals with limited medical/ultrasound experience as it requires minimal anatomical knowledge and technical skill. In VSI, the target organ is imaged with a series of sweeps and arcs of the ultrasound probe in relation to external body landmarks. Methods Rural health workers in Peru were trained on a VSI ultrasound protocol for pneumonia detection. Subjects were given a brief didactic session followed by hands-on practice with the protocol. Each attempt was timed and mistakes were recorded. Participants performed the protocol until they demonstrated two mistake-free attempts. Results It took participants a median number of three attempts (range 1-6) to perform the VSI protocol correctly. Time to mastery took 51.4 ± 17.7 min. There were no significant differences among doctors, nurses, and technicians in total training time (P = 0.43) or number of attempts to success (P = 0.72). Trainee age was not found to be significantly correlated with training time (P = 0.50) or number of attempts to success (P = 0.40). Conclusion Rural health workers learned a VSI protocol for pneumonia detection with relative ease in a short amount of time. Future studies should investigate the clinical efficacy of this VSI protocol for pneumonia detection. Key message A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience. No difference was found in training performance related to education level or age. VSI involves no significant knowledge of anatomy or technical skill.
29 citations
Cites result from "Lung Ultrasound is Comparable with ..."
...Lung ultrasound (LUS) has been verified by numerous studies as superior in sensitivity and specificity for pneumonia detection when compared to the historic “gold-standard” of chest X-ray in adults and children.[9-15] Ultrasound is ideal in children to assess for pneumonia due to their small thoracic diameter, and it does not expose children to ionizing radiation....
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References
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TL;DR: The four articles in this special section onMeta-analysis illustrate some of the complexities entailed in meta-analysis methods and contributes both to advancing this methodology and to the increasing complexities that can befuddle researchers.
Abstract: During the past 30 years, meta-analysis has been an indispensable tool for revealing the hidden meaning of our research literatures. The four articles in this special section on meta-analysis illus...
20,272 citations
"Lung Ultrasound is Comparable with ..." refers background in this paper
...reported that LUS has a sensitivity of 96% and specificity of 93% for diagnosing CAP in children [25]....
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01 Jul 1959
TL;DR: Recommendations are presented which represent concepts and practices evolved from recent discussions at formal and informal meetings of the Commission and its Committees.
Abstract: The International Commission on Radiological Protection has been functioning since 1928 when it was established, under the name of International X- ray and Radium Protection Commission, by the Second International Congress of Radiology held in Stockholm, Sweden. It assumed the present name and organizational form in 1950 in order to cover more effectively the rapidly expanding field of radiation protection. Recommendations are presented which represent concepts and practices evolved from recent discussions at formal and informal meetings of the Commission and its Committees. (auth)
6,166 citations
Journal Article•
5,934 citations
Gonzaga University1, King Saud University2, Northside Hospital3, Praxis4, Foothills Medical Centre5, Cornell University6, National Research Council7, Harvard University8, University of Pennsylvania9, Icahn School of Medicine at Mount Sinai10, University of Jena11, Pierre-and-Marie-Curie University12, University of California, Davis13, University of South Carolina14
TL;DR: This document reflects the overall results of the first consensus conference on “point-of-care” lung ultrasound and utilizes the RAND appropriateness method for panel judgment and decisions/consensus.
Abstract: The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings. A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus. Seventy-three proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear. This document reflects the overall results of the first consensus conference on “point-of-care” lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.
2,073 citations
"Lung Ultrasound is Comparable with ..." refers background in this paper
...There is an increasing evidence of LUS as a diagnostic modality in children and therefore it is being recommended as an investigation in CAP before CXR [20]....
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...The LUS findings including single or multiple irregular sub-pleural hypoechogenic area with or without air bronchograms, superficial fluid alveologram, the presence of pleural effusion, focal multiple or confluent B-lines, pleural line abnormalities defined as the irregular appearance of the pleural line were considered for the diagnosis of CAP [19, 20]....
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University of California, San Diego1, University of Utah2, University of Pennsylvania3, Rhode Island Hospital4, Boston Children's Hospital5, Children's Mercy Hospital6, Baylor College of Medicine7, Cleveland Clinic8, University of Texas Southwestern Medical Center9, Centers for Disease Control and Prevention10, University of Missouri–Kansas City11, Emory University12
TL;DR: Eidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery.
Abstract: Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
1,333 citations
"Lung Ultrasound is Comparable with ..." refers background in this paper
...As per WHO and other recommendations [3, 4], diagnosis and classification of CAP is largely clinical and chest radiography is recommended in severe and complicated cases only....
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