Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children
Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children
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DOI：
10.1016/j.rmed.2015.06.011
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发表时间：
2015-09-01
影响因子：
4.3
通讯作者：
Kulus, Marek
中科院分区：
文献类型：
--
作者：
Urbankowska, Emilia;Krenke, Katarzyna;Kulus, Marek
肺部超声 (LUS) 是一种易于使用、无辐射的成像技术，可用作社区获得性肺炎 (CAP) 的诊断工具。该研究的目的是评估 LUS 在诊断和监测儿童 CAP 方面的有用性和准确性。连续招募了 106 名年龄在 1 至 213 个月（中位数 52.5）个月之间因怀疑患有 CAP 而转诊到医院的儿童。所有患者均在入院当天接受 LUS，随后进行胸部 X 光检查 (CXR)。入院后第5-7天的25名儿童和第10-14天的31名儿童也进行了肺部超声检查。76名儿童的放射学检查显示肺炎症状，而71名儿童的肺部超声检查显示与肺炎相符的肺部异常。 LUS 对 5 名 CXR 证实存在肺门旁肺部浸润的患者给出了假阴性结果。 LUS 和 CXR 在肺炎诊断方面几乎完全一致（Cohen kappa 系数为 0.89）。 LUS对肺部受累的诊断表现如下：敏感性为93.4%，特异性为100%，阳性预测值为100%，阴性预测值为85.7%，准确性为95.3%。我们的研究表明，LUS是CAP儿童的一种敏感且高度特异性的诊断方法。因此，LUS可被考虑作为疑似CAP儿童的首选影像学检查。包括 LUS 在内的 CAP 诊断算法应在前瞻性研究中进行验证。肺部超声检查还可用于追踪肺部病变的消退情况。 (C) 2015 Elsevier Ltd. 保留所有权利。
Lung ultrasound (LUS) is as an easily accessible, radiation-free imaging technique that might be used as a diagnostic tool in community-acquired pneumonia (CAP).The aim of the study was to evaluate the usefulness and accuracy of LUS in the diagnosis and monitoring of childhood CAP.One hundred six consecutive children aged between 1 and 213 (median 52.5) months referred to the hospital with suspicion of CAP were enrolled. All patients underwent LUS on the day of admission, followed by chest radiograph (CXR). Lung ultrasound was also performed in 25 children between 5th -7th and 31 children between 10th-14th day after admission.Radiographic signs of pneumonia were demonstrated in 76 children, while lung ultrasound revealed pulmonary abnormalities consistent with pneumonia in 71 children. LUS gave false negative results in 5 patients with parahilar pulmonary infiltrates demonstrated by CXR. Almost perfect overall agreement between LUS and CXR was found in terms of pneumonia diagnosis (Cohen kappa coefficient of 0.89). The diagnostic performance of LUS in demonstration of lung involvement was as follows: sensitivity of 93.4%, specificity of 100%, positive predictive value of 100%, negative predictive value of 85.7% and accuracy of 95.3%.Our study showed that LUS is a sensitive and highly specific diagnostic method in children with CAP.Therefore, LUS may be considered as the first imaging test in children with suspicion of CAP. A diagnostic algorithm of CAP which includes LUS should be validated in prospective studies. Lung ultrasound can also be used to follow-up resolution of pneumonic lesions. (C) 2015 Elsevier Ltd. All rights reserved.