Pediatric Pneumonia Can Be Diagnosed via Lung Ultrasound

Lung ultrasound (LUS) may offer a safer, yet equally effective, alternative to chest X-rays (CXR) for diagnosing pneumonia in children, according to a new study.

Researchers at Mount Sinai School of Medicine (New York, NY, USA) and Vanderbilt University (Nashville, TN, USA) conducted a randomized control trial comparing LUS to CXR in 191 children from birth to 21 years of age with suspected pneumonia in an emergency department (ED). Patients in the investigational arm received a LUS; if there was clinical uncertainty after ultrasound, clinicians had the option to obtain CXR. Those in the CXR group had a chest X-ray, followed by lung ultrasound. The primary outcome was the rate of CXR reduction.

The results showed that the patients in the investigational group had a 38.8% reduction in chest X-rays, with no missed cases of pneumonia and no increase in complications, adverse events, or subsequent unscheduled healthcare visits. Novice and experienced clinicians achieved a 30% and 60.6% reduction in CXR use, respectively. The reduction in chest X-rays led to overall cost savings of USD 9,200 per patient, and an average decrease in time spent in the emergency department of 26 minutes. The study was published in the March 2016 issue of Chest.

“Ultrasound is portable, cost-saving, and safer for children than an X-ray because it does not expose them to radiation. In the era of precision medicine, lung ultrasound may also be an ideal imaging option in children who are at higher risk for radiation-induced cancers or have received multiple radiographic or CT imaging studies,” said lead author James Tsung, MD, MPH. “Our study could have a profound impact in the developing world where access to radiography is limited.”

Pneumonia is the leading cause of death in children worldwide, according to the World Health Organization (WHO, Geneva, Switzerland). Symptoms include fever, cough, and rapid breathing. CXR is considered the test of choice for diagnosing pneumonia in children, but the WHO estimates three-quarters of the world's population does not have access to radiography.

Related Links:
Mount Sinai School of Medicine
Vanderbilt University
World Health Organization