Skip to main content
Top
Published in: Italian Journal of Pediatrics 1/2014

Open Access 01-12-2014 | Research

Performance of lung ultrasonography in children with community-acquired pneumonia

Published in: Italian Journal of Pediatrics | Issue 1/2014

Login to get access

Abstract

Background

There are few prospective evaluations of point-of-care ultrasonography (US) for the diagnosis of pediatric community-acquired pneumonia (CAP). In particular, there are very few data concerning the efficiency of US in comparison with that of chest radiography (CR) in defining different kinds of lung alterations in the various pulmonary sections. The aim of this study was to bridge this gap in order to increase our knowledge of the performance of US in diagnosing CAP in childhood.

Methods

A total of 103 children (56 males, 54.4%; mean age ± standard deviation 5.6 ± 4.6 years) admitted to hospital with a clinical diagnosis of suspected CAP were prospectively enrolled and underwent CR (evaluated by an independent expert radiologist) and lung US (performed by a resident in paediatrics with limited experience in US). The performance of US in diagnosing CAP (i.e. its sensitivity, specificity, and positive and negative predictive values) was compared with that of CR.

Results

A total of 48 patients had radiographically confirmed CAP. The sensitivity, specificity, and positive and negative predictive values of US in comparison with CR were respectively 97.9%, 94.5%, 94.0% and 98.1%. US identified a significantly higher number of cases of pleural effusion, but the concordance of the two methods in identifying the type of CAP was poor.

Conclusion

US can be considered a useful means of diagnosing CAP in children admitted to an Emergency Department with a lower respiratory tract infection, although its usefulness in identifying the type of lung involvement requires further evaluation.
Literature
1.
go back to reference Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreño RA, Nohynek H, Riley ID, Makela H: Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev. 2009, 4: CD004977-PubMed Lucero MG, Dulalia VE, Nillos LT, Williams G, Parreño RA, Nohynek H, Riley ID, Makela H: Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database Syst Rev. 2009, 4: CD004977-PubMed
2.
go back to reference McIntosh K: Community-acquired pneumonia in children. N Engl J Med. 2002, 346: 429-437. 10.1056/NEJMra011994.CrossRefPubMed McIntosh K: Community-acquired pneumonia in children. N Engl J Med. 2002, 346: 429-437. 10.1056/NEJMra011994.CrossRefPubMed
3.
go back to reference Principi N, Esposito S: Paediatric community-acquired pneumonia: current concepts in pharmacological control. Expert Opin Pharmacother. 2003, 4: 761-777. 10.1517/14656566.4.5.761.CrossRefPubMed Principi N, Esposito S: Paediatric community-acquired pneumonia: current concepts in pharmacological control. Expert Opin Pharmacother. 2003, 4: 761-777. 10.1517/14656566.4.5.761.CrossRefPubMed
4.
go back to reference Principi N, Esposito S: Management of severe community-acquired pneumonia of children in developing and developed countries. Thorax. 2011, 66: 815-822. 10.1136/thx.2010.142604.CrossRefPubMed Principi N, Esposito S: Management of severe community-acquired pneumonia of children in developing and developed countries. Thorax. 2011, 66: 815-822. 10.1136/thx.2010.142604.CrossRefPubMed
5.
go back to reference Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A, British Thoracic Society Standards of Care Committee: British thoracic society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011, 66: ii1-ii23.CrossRefPubMed Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, Thomson A, British Thoracic Society Standards of Care Committee: British thoracic society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011, 66: ii1-ii23.CrossRefPubMed
6.
go back to reference Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, St Peter SD, Stockwell JA, Swanson JT: The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011, 53: e25-e76. 10.1093/cid/cir531.CrossRefPubMed Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, St Peter SD, Stockwell JA, Swanson JT: The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011, 53: e25-e76. 10.1093/cid/cir531.CrossRefPubMed
7.
go back to reference Esposito S, Cohen R, Domingo JD, Pecurariu OF, Greenberg D, Heininger U, Knuf M, Lutsar I, Principi N, Rodrigues F, Sharland M, Spoulou V, Syrogiannopoulos GA, Usonis V, Vergison A, Schaad UB: Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat?. Pediatr Infect Dis J. 2012, 31: e78-e85. 10.1097/INF.0b013e318255dc5b.CrossRefPubMed Esposito S, Cohen R, Domingo JD, Pecurariu OF, Greenberg D, Heininger U, Knuf M, Lutsar I, Principi N, Rodrigues F, Sharland M, Spoulou V, Syrogiannopoulos GA, Usonis V, Vergison A, Schaad UB: Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat?. Pediatr Infect Dis J. 2012, 31: e78-e85. 10.1097/INF.0b013e318255dc5b.CrossRefPubMed
8.
go back to reference Davies HD, Wang EE, Manson D, Babyn P, Shuckett B: Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. Pediatr Infect Dis J. 1996, 15: 600-604. 10.1097/00006454-199607000-00008.CrossRefPubMed Davies HD, Wang EE, Manson D, Babyn P, Shuckett B: Reliability of the chest radiograph in the diagnosis of lower respiratory infections in young children. Pediatr Infect Dis J. 1996, 15: 600-604. 10.1097/00006454-199607000-00008.CrossRefPubMed
9.
go back to reference Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB: The air bronchogram: sonographic demonstration. AJR Am J Roentgenol. 1986, 147: 593-595. 10.2214/ajr.147.3.593.CrossRefPubMed Weinberg B, Diakoumakis EE, Kass EG, Seife B, Zvi ZB: The air bronchogram: sonographic demonstration. AJR Am J Roentgenol. 1986, 147: 593-595. 10.2214/ajr.147.3.593.CrossRefPubMed
10.
go back to reference Parlamento S, Copetti R, Di Bartolomeo S: Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009, 27: 379-384. 10.1016/j.ajem.2008.03.009.CrossRefPubMed Parlamento S, Copetti R, Di Bartolomeo S: Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009, 27: 379-384. 10.1016/j.ajem.2008.03.009.CrossRefPubMed
11.
go back to reference Sperandeo M, Carnevale V, Muscarella S, Sperandeo G, Varriale A, Filabozzi P, Piattelli ML, D’Alessandro V, Copetti M, Pellegrini F, Dimitri L, Vendemiale G: Clinical application of transthoracic ultrasonography in inpatients with pneumonia. Eur J Clin Invest. 2011, 41: 1-7.CrossRefPubMed Sperandeo M, Carnevale V, Muscarella S, Sperandeo G, Varriale A, Filabozzi P, Piattelli ML, D’Alessandro V, Copetti M, Pellegrini F, Dimitri L, Vendemiale G: Clinical application of transthoracic ultrasonography in inpatients with pneumonia. Eur J Clin Invest. 2011, 41: 1-7.CrossRefPubMed
12.
go back to reference Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G, Picano E: Lung ultrasound in bronchiolitis: comparison with chest X-ray. Eur J Pediatr. 2011, 170: 1427-1433. 10.1007/s00431-011-1461-2.CrossRefPubMed Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G, Picano E: Lung ultrasound in bronchiolitis: comparison with chest X-ray. Eur J Pediatr. 2011, 170: 1427-1433. 10.1007/s00431-011-1461-2.CrossRefPubMed
13.
go back to reference Reissig A, Copetti R, Mathis G, Mempel C, Schuler A, Zechner P, Aliberti S, Neumann R, Kroegel C, Hoyer H: Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest. 2012, 142: 965-972. 10.1378/chest.12-0364.CrossRefPubMed Reissig A, Copetti R, Mathis G, Mempel C, Schuler A, Zechner P, Aliberti S, Neumann R, Kroegel C, Hoyer H: Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest. 2012, 142: 965-972. 10.1378/chest.12-0364.CrossRefPubMed
14.
go back to reference Cortellaro F, Colombo S, Coen D, Duca PG: Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012, 29: 19-23. 10.1136/emj.2010.101584.CrossRefPubMed Cortellaro F, Colombo S, Coen D, Duca PG: Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J. 2012, 29: 19-23. 10.1136/emj.2010.101584.CrossRefPubMed
15.
go back to reference Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS): International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012, 38: 577-591. 10.1007/s00134-012-2513-4.CrossRefPubMed Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS): International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012, 38: 577-591. 10.1007/s00134-012-2513-4.CrossRefPubMed
16.
go back to reference Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G, Picano E, Mele G: Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol. 2013, 48: 280-287. 10.1002/ppul.22585.CrossRefPubMed Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G, Picano E, Mele G: Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol. 2013, 48: 280-287. 10.1002/ppul.22585.CrossRefPubMed
17.
go back to reference Shah VP, Tunik MG, Tsung JW: Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. 2013, 167: 119-125. 10.1001/2013.jamapediatrics.107.CrossRefPubMed Shah VP, Tunik MG, Tsung JW: Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. 2013, 167: 119-125. 10.1001/2013.jamapediatrics.107.CrossRefPubMed
19.
go back to reference Copetti R, Cattarossi L: Ultrasound diagnosis of pneumonia in children. Radiol Med. 2008, 113: 190-198. 10.1007/s11547-008-0247-8.CrossRefPubMed Copetti R, Cattarossi L: Ultrasound diagnosis of pneumonia in children. Radiol Med. 2008, 113: 190-198. 10.1007/s11547-008-0247-8.CrossRefPubMed
20.
go back to reference Armitage P, Berry G, Matthews JNS: Statistical Methods in Medical Research. 2002, Oxford: Blackwell Science, 4CrossRef Armitage P, Berry G, Matthews JNS: Statistical Methods in Medical Research. 2002, Oxford: Blackwell Science, 4CrossRef
21.
go back to reference Maxwell AE: Comparing the classification of subjects by two independent judges. Brit J Psychiatr. 1970, 116: 651-655. 10.1192/bjp.116.535.651.CrossRef Maxwell AE: Comparing the classification of subjects by two independent judges. Brit J Psychiatr. 1970, 116: 651-655. 10.1192/bjp.116.535.651.CrossRef
22.
go back to reference Stuart A: A test for homogeneity of the marginal distributions in a two-way classification. Biometrika. 1955, 42: 412-416. 10.1093/biomet/42.3-4.412.CrossRef Stuart A: A test for homogeneity of the marginal distributions in a two-way classification. Biometrika. 1955, 42: 412-416. 10.1093/biomet/42.3-4.412.CrossRef
23.
go back to reference Ait-Ali L, Andreassi MG, Foffa I, Spadoni I, Vano E, Picano E: Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart. 2010, 96: 269-274. 10.1136/hrt.2008.160309.CrossRefPubMed Ait-Ali L, Andreassi MG, Foffa I, Spadoni I, Vano E, Picano E: Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart. 2010, 96: 269-274. 10.1136/hrt.2008.160309.CrossRefPubMed
24.
go back to reference Zimmerman DR, Kovalski N, Fields S, Lumelsky D, Miron D: Diagnosis of childhood pneumonia: clinical assessment without radiological confirmation may lead to overtreatment. Pediatr Emerg Care. 2012, 28: 646-649. 10.1097/PEC.0b013e31825cfd53.CrossRefPubMed Zimmerman DR, Kovalski N, Fields S, Lumelsky D, Miron D: Diagnosis of childhood pneumonia: clinical assessment without radiological confirmation may lead to overtreatment. Pediatr Emerg Care. 2012, 28: 646-649. 10.1097/PEC.0b013e31825cfd53.CrossRefPubMed
25.
go back to reference Patria MF, Longhi B, Lelii M, Galeone C, Pavesi MA, Esposito S: Association between radiological findings and severity of community-acquired pneumonia in children. Ital J Pediatr. 2013, 39: 56-10.1186/1824-7288-39-56.PubMedCentralCrossRefPubMed Patria MF, Longhi B, Lelii M, Galeone C, Pavesi MA, Esposito S: Association between radiological findings and severity of community-acquired pneumonia in children. Ital J Pediatr. 2013, 39: 56-10.1186/1824-7288-39-56.PubMedCentralCrossRefPubMed
26.
go back to reference Sorantin E, Weissensteiner S, Hasenburger G, Riccabona M: CT in children–dose protection and general considerations when planning a CT in a child. Eur J Radiol. 2013, 82: 1043-1049. 10.1016/j.ejrad.2011.11.041.CrossRefPubMed Sorantin E, Weissensteiner S, Hasenburger G, Riccabona M: CT in children–dose protection and general considerations when planning a CT in a child. Eur J Radiol. 2013, 82: 1043-1049. 10.1016/j.ejrad.2011.11.041.CrossRefPubMed
27.
go back to reference Riccabona M: Ultrasound of the chest in children (mediastinum excluded). Eur Radiol. 2008, 18: 390-399. 10.1007/s00330-007-0754-3.CrossRefPubMed Riccabona M: Ultrasound of the chest in children (mediastinum excluded). Eur Radiol. 2008, 18: 390-399. 10.1007/s00330-007-0754-3.CrossRefPubMed
28.
go back to reference Grisaru-Soen G, Eisenstadt M, Paret G, Schwartz D, Keller N, Nagar H, Reif S: Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management. Pediatr Emerg Care. 2013, 29: 425-429. 10.1097/PEC.0b013e318289e810.CrossRefPubMed Grisaru-Soen G, Eisenstadt M, Paret G, Schwartz D, Keller N, Nagar H, Reif S: Pediatric parapneumonic empyema: risk factors, clinical characteristics, microbiology, and management. Pediatr Emerg Care. 2013, 29: 425-429. 10.1097/PEC.0b013e318289e810.CrossRefPubMed
Metadata
Title
Performance of lung ultrasonography in children with community-acquired pneumonia
Publication date
01-12-2014
Published in
Italian Journal of Pediatrics / Issue 1/2014
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/1824-7288-40-37

Other articles of this Issue 1/2014

Italian Journal of Pediatrics 1/2014 Go to the issue