Not that thoracic bedside ultrasound is only good for children’s pneumonia – as we know there have been recent articles ….and posts here on SonoSpot summarizing the recent hot topic (including one from Blaivas from the Journal of US in Medicine, and another highlighted in our bi-annual Northern CA Journal Club) …that it can help in diagnosing adult pneumonia too – but this topic is getting quite a bit of press lately due to the affect of it with our kids in another study recently published – decreasing radiation? decreasing length of stay? decreasing cost? increasing satisfaction? yes, please.
The actual pediatric study (abstract) can be found here. It states: just after 1 hour of clinicians learning how to do it, they were able to diagnose pneumonia with ultrasound (chest Xray used as a reference standard). 200 patients (!!) were studied with the prevalence of pneumonia by chest XRay was 18%. “Ultrasonography had an overall sensitivity of 86% (95% CI, 71%-94%), specificity of 89% (95% CI, 83%-93%), positive LR of 7.8 (95% CI, 5.0-12.4), and negative LR of 0.2 (95% CI, 0.1-0.4) for diagnosing pneumonia by visualizing lung consolidation with sonographic air bronchograms. In subgroup analysis of 187 patients having lung consolidation exceeding 1 cm, ultrasonography had a sensitivity of 86% (95% CI, 71%-94%), specificity of 97% (95% CI, 93%-99%), positive LR of 28.2 (95% CI, 11.8-67.6) and negative LR of 0.1 (95% CI, 0.1-0.3) for diagnosing pneumonia.” To view another study from 2009 (!!) where they compared ultrasound to CT, go here. Or one from 2009 from the Italians (because they do everything better) go here.
Medwire from ACEP News has spread the word recently too: “Point-of-care ultrasound scanning can be used to diagnose pneumonia accurately in children and young people, show study findings. Researchers led by James Tsung, from Mount Sinai School of Medicine in New York, USA, hope that their findings could help diagnose children with pneumonia in developing countries, where deaths from the disease are particularly high. “The World Health Organization has estimated as many as three-quarters of the world’s population, especially in the developing world, does not have access to any diagnostic imaging, such as chest X-ray, to detect pneumonia,” said Tsung in a press statement. “Many children treated with antibiotics may only have a viral infection – not pneumonia. Portable ultrasound machines can provide a more accurate diagnosis of pneumonia than a stethoscope.” Tsung and colleagues enrolled 200 patients under the age of 21 years to take part in their study. All patients had suspected community-acquired pneumonia and all diagnoses were checked using chest radiography. The clinicians involved in the study had 1 hour of focused training in ultrasonography to diagnose pneumonia in children and young people. As reported in the Archives of Pediatric and Adolescent Medicine, the patients were aged a median of 3 years and chest radiography diagnosed pneumonia in 18% of the group. Ultrasonography, involving visualization of lung consolidation with sonographic air bronchograms, accurately diagnosed pneumonia in the majority of cases, with a sensitivity of 86%, a specificity of 89%, a positive likelihood ratio (LR) of 7.8, and a negative LR of 0.2. In patients with lung consolidation of over 1 cm, point-of-care ultrasound was even more accurate, with a sensitivity of 86%, specificity of 97%, positive LR of 28.2, and negative LR of 0.1 for diagnosing pneumonia. Kassa Darge and Aaron Chen (The Children’s Hospital of Philadelphia, Pennsylvania, USA), the authors of an accompanying editorial, say that further studies are needed to confirm these results. However, they conclude: “In the future, wherever the institutional infrastructure permits, in the diagnostic imaging algorithm for suspected pneumonia in children, ultrasonography may need to precede, augment, or even replace chest radiography.”
Oh yeah…..let the ultrasoundin’ begin!
For a very fun and funny podcast by the Ultrasound Podcast guys, go here.
For a great and complete pdf lecture on Lung ultrasound by the Critical Care Ultrasound God – aka Lichtenstein – go here.
What it can look like: look for the bright white (hyperechoic) areas within lung: