Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings
Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings
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DOI：
10.1016/j.rmed.2017.05.007
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发表时间：
2017-07-01
影响因子：
4.3
通讯作者：
Checkley, William
中科院分区：
文献类型：
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作者：
Ellington, Laura E.;Gilman, Robert H.;Checkley, William
背景：肺炎是全世界儿童发病和死亡的主要原因；然而，其诊断可能具有挑战性，特别是在缺乏熟练临床医生或标准成像的情况下。我们试图确定肺部超声与影像学确诊的临床小儿肺炎的诊断准确性。方法：2012年1月至2013年9月期间，我们连续招募了秘鲁利马国家儿童健康研究所门诊部、急诊部和住院部的2-59个月有原发性呼吸道疾病的儿童。所有参与者都接受了儿科医生的临床评估和三名全科医生之一的肺部超声检查。我们还连续招募了没有呼吸道症状的儿童。有呼吸道症状的儿童接受了胸部X光检查。我们对子集进行了辅助实验室检测。结果：最终临床诊断包括 453 名儿童肺炎、133 名哮喘儿童、103 名细支气管炎儿童和 143 名上呼吸道感染儿童。总共 453 名临床肺炎儿童中，CXR 确诊了 191 名（42%）。与放射学确诊的临床肺炎相比，肺部超声巩固是我们治疗肺炎的主要终点，其敏感性为 88.5%，特异性为 100%，曲线下面积为 0.94 (95% CI 0.92-0.97)。当肺部超声异常与影像学确诊的临床肺炎进行比较时，敏感性增加至 92.2%，特异性下降至 95.2%，曲线下面积为 0.94 (95% CI 0.91-0.96)。 结论：肺部超声对影像学确诊的肺炎具有较高的诊断准确性。肺部超声的额外好处包括快速测试和评估者之间的高度一致性。肺部超声可以作为诊断小儿肺炎的替代工具。 (C) 2017 年作者。由爱思唯尔有限公司出版
Background: Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia.Methods: Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Institute Nacional de Salud del Nino in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset.Results: Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91-0.96).Conclusions: Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia. (C) 2017 The Author(s). Published by Elsevier Ltd.