Performance of lung ultrasonography for the diagnosis of communityacquired pneumonia in hospitalized children.

Abstract

The objective of the study was to assess the performance of lung ultrasonography (LUS) as compared to chest radiographyand the clinical criteria for the diagnosis of pneumonia in children. This was a retrospectivestudy in which data were collected from medical files of 81 children admitted with a clinical suspicion of pneumonia in whichboth an LUS and a chest radiograph during the hospitalization were performed. Reference standard used for the diagnosis ofpneumonia were chest radiographs (consolidation, parenchymal infiltrates, and interstitial infiltrate) and clinical criteria. LUSfindings were reported as normal, parenchymal consolidations and pleural effusions. Radiological pneumonia wasreported in 72 of the 81 patients (88.9%). LUS identified parenchymal consolidations in 62 cases. LUS correctly identifiedradiological pneumonia with a sensitivity of 79.2% and a specificity of 44.4%. The positive predictive value (PPV) was 91.9%and the negative predictive value (NPV) was 21.0%. When clinical criteria were used as reference standard, the sensitivity,specificity, PPV and NPV of correctly identifying clinical pneumonia cases by LUS (only consolidations) were 80.0%, 66.7%,96.8% and 21.0%. When indicative for the presence of pneumonia either the ultrasound consolidation or the ultrasound detectedpleural effusion were considered when the sensitivity, PPV and NPV increased to 96.0% (95%CI: 88.8-99.2), 97.3%(95%CI: 92.0-99.1), and 57.1% (95%CI: 27.7-82.2), respectively. In our opinion, our findings together withprevious ones available in the literature recommend LUS as a valuable investigation for the diagnosis of community-acquiredpneumonia in children.