Accuracy of lung ultrasonography in diagnosis of community acquired pneumonia in hospitalized children as compared to chest x-ray

Abstract

Background: The ultrasound signs of lung and pleural diseases described in adults are also found in pediatric patients. LUS is at least as accurate as chest radiography in diagnosing pneumonia. The objective of the study was to define the lung ultrasonography (LUS) characteristics at presentation and follow up of hospitalized children with community acquired pneumonia (CAP) and to define the accuracy of LUS as compared to chest X-ray (CXR) in diagnosing CAP. Methods: It was a hospital based prospective study done at department of paediatrics, SMS hospital, Jaipur. A total of 139 children between 2 months to 18 years of age admitted in hospital with diagnosis of CAP who fulfilled the inclusion and exclusion criteria were included in the study after obtaining informed written consent. Clinical driven CXR was done on day of the admission. LUS was done in all patients. The LUS findings obtained were compared with those of CXR. The data was analyzed by using standard statistical methods. Results: Of 139 patients, LUS characteristically shows sub pleural consolidation (absolute consolidation or with other findings) in 93.5 % (130/139), confluent B-lines abnormalities 35.9 % (50/139), pleural line abnormalities in 17.2% (24/139), and pleural effusion in 15.8 % (22/139) patients, while LUS was indicative of pneumonia in 136 (97.84%), CXR was suggestive of pneumonia in 126 (90.64%) patients (p <0.01). The LUS had sensitivity of 97.84%. Consolidation was reported in 130 (93.53%) patients by LUS as compared to 107 (76.97%) patients by CXR (p<0.001). During follow up, LUS in seven patient initially showed increase in size of consolidation consistent with clinical deterioration then gradual decrease in size of consolidation due change in antibiotics. Conclusions: LUS was highly accurate for the diagnosis as well as for follow up of CAP in hospitalized children. It avoids the use of ionizing radiation. Therefore, the use of ultrasound needs to be encouraged not just as a valid diagnostic alternative but as a necessary ethical choice.