Clinical question: Can bedside ultrasound reliably diagnose pneumonia in children?
Background: Pneumonia is the most common cause of death in children worldwide, one of the most common causes of inpatient admission for children in the U.S., and carries estimated costs of about $1 billion per year. Its diagnosis can challenge clinicians and require radiographic and laboratory studies. Chest radiographs require specialized equipment, expertise to interpret, and ionizing radiation exposure. Radiographic findings can also lag behind the clinical picture. Ultrasound, a rapid, noninvasive, portable, and inexpensive imaging modality that can be taught quickly, is widely used to diagnose such pediatric conditions as appendicitis and abscess and may be useful in diagnosing pediatric pneumonia.
Study design: Meta-analysis.
Setting: Eight studies reviewed and synthesized (three ED, two regular inpatient, one PICU, two NICU).
Synopsis: Lung ultrasound was compared to chest radiograph, lab findings, and clinical findings for detection of pneumonia. In pooled analysis, lung ultrasound was 96% sensitive and 93% specific for the diagnosis of pneumonia with area under the receiver operating characteristic (ROC) curve of 0.98 (95% CI 0.96-1). Subgroup analysis showed that having physicians who have had experience with more than 100 ultrasounds or radiologists performing the ultrasounds increased the sensitivity to 97% and the specificity to 99%. Novice users could detect pneumonia with less reliability.
Bottom line: Lung ultrasound is a promising and potentially reliable modality for diagnosis of pneumonia. This may prove especially useful in resource-poor settings or in clinics without access to chest radiographs.
Citation: Pereda MA, Chavez MA, Hooper-Miele CC, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta analysis. Pediatrics. 2015;135(4):714-722.
Dr. Stubblefield is a pediatric hospitalist at Nemours/Alfred I. Dupont Hospital for Children in Wilmington, Del., and assistant professor of pediatrics at Thomas Jefferson Medical College in Philadelphia.
