Article Text

other Versions

PDF
Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze
  1. Terry Varshney1,
  2. Elise Mok2,
  3. Adam J Shapiro3,
  4. Patricia Li2,4,
  5. Alexander S Dubrovsky2,5
  1. 1Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
  2. 2Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
  3. 3Department of Pediatric Respirology, Montreal Children's Hospital—McGill University Health Center, Montreal, Quebec, Canada
  4. 4Departments of Pediatrics, Montreal Children's Hospital—McGill University Health Center, Montreal, Quebec, Canada
  5. 5Department of Pediatric Emergency Medicine, Montreal Children's Hospital—McGill University Health Center, Montreal, Quebec, Canada
  1. Correspondence to Dr Alexander Sasha Dubrovsky; Montreal Children's Hospital, McGill University Health Center, 1001 Decarie Boulevard, Montreal, Quebec, Canada H4A 3J1; sasha.dubrovsky{at}mcgill.ca

Abstract

Objective Characterise lung ultrasound (LUS) findings, diagnostic accuracy and agreement between novice and expert interpretations in young children with respiratory tract infections and wheeze.

Methods Prospective cross-sectional study in a paediatric ED. Patients ≤2 years with a respiratory tract infection and wheeze at triage were recruited unless in severe respiratory distress. Prior to clinical management, a novice sonologist performed the LUS using a six-zone scanning protocol. The treating physician remained blinded to ultrasound findings; final diagnoses were extracted from the medical record. An expert sonologist, blinded to all clinical information, assessed the ultrasound video clips at study completion. Positive LUS was defined as the presence of ≥1 of the following findings: ≥3 B-lines per intercostal space, consolidation and/or pleural abnormalities.

Results Ninety-four patients were enrolled (median age 11.1 months). LUS was positive in 42% (39/94) of patients (multiple B-lines in 80%, consolidation in 64%, pleural abnormalities in 23%). The proportion of positive LUS, along with their diagnostic accuracy (sensitivity (95% CI), specificity (95% CI)), were as follows for children with bronchiolitis, asthma, pneumonia and asthma/pneumonia: 46% (45.8% (34.0% to 58.0%), 72.7% (49.8% to 89.3%)), 0% (0% (0.0% to 23.3%), 51.3% (39.8% to 62.6%)), 100% (100% (39.8% to 100.0%), 61.1% (50.3% to 71.2%)), 50% (50% (6.8% to 93.2%), 58.9% (48.0% to 69.2%)), respectively. There was good agreement between the novice and expert sonographers for a positive LUS (kappa 0.68 (95% CI 0.54 to 0.82)).

Conclusions Among children with respiratory tract infections and wheeze, a positive LUS seems to distinguish between clinical syndromes by ruling in pneumonia and ruling out asthma. If confirmed in future studies, LUS may emerge as a point-of-care tool to guide diagnosis and disposition in young children with wheeze.

  • ultrasound
  • pneumonia/infections
  • paediatrics, paediatric emergency medicine
  • asthma
  • infectious diseases, viral

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.