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      Lung ultrasound for the diagnosis of childhood pneumonia: a safe and accurate imaging mode

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          Abstract

          Pneumonia is the most common infectious cause of mortality in children worldwide. Chest x-ray (CXR) has been used as a supplementary mode in the diagnosis of pneumonia in children, but its frequent use might expose children to unnecessary ionizing radiation. In this review, we present up-to-date data of an alternative mode of imaging other than CXR in the diagnosis of pneumonia in children. We found that lung ultrasound is a safe and accurate mode of imaging that can be used by a health care provider in the cases of suspected pneumonia. It is more sensitive than CXR in the diagnosis of pneumonia and obviates the need for irradiation.

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          Most cited references 5

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          Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis.

          Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia.
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            Ultrasound diagnosis of pneumonia in children.

            This study was done to compare the diagnostic accuracy of ultrasound and chest X-ray (CXR) in children with suspected pneumonia. Seventy-nine children aged from 6 months to 16 years with clinical signs suggestive of pneumonia underwent lung ultrasound and CXR. Lung ultrasound was positive for the diagnosis of pneumonia in 60 patients, whereas CXR was positive in 53. In four patients with negative CXR and positive ultrasound findings, pneumonia was confirmed by chest computed tomography (CT) (performed for recurrent pneumonia in the same location). In the other three patients with negative CXR and positive ultrasound findings, the clinical course was consistent with pneumonia. Lung ultrasound is a simple and reliable tool that can be used by the clinician in the case of suspected pneumonia. It is as reliable as CXR, can be easily repeated at the patient's bedside and carries no risk of irradiation.
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              Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults.

              To determine the accuracy of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults by a group of clinicians. Prospective observational cohort study. Two urban emergency departments. Patients from birth to age 21 years undergoing chest radiography for suspected community-acquired pneumonia. After documenting clinical examination findings, clinicians with 1 hour of focused training used ultrasonography to diagnose pneumonia in children and young adults. Test performance characteristics for the ability of ultrasonography to diagnose pneumonia were determined using chest radiography as a reference standard. Subgroup analysis was performed in patients having lung consolidation exceeding 1 cm with sonographic air bronchograms detected on ultrasonography; specificity and positive likelihood ratio (LR) were calculated to account for lung consolidation of 1 cm or less with sonographic air bronchograms undetectable by chest radiography. Two hundred patients were studied (median age, 3 years; interquartile range, 1-8 years); 56.0% were male, and the prevalence of pneumonia by chest radiography was 18.0%. 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. Clinicians are able to diagnose pneumonia in children and young adults using point-of-care ultrasonography, with high specificity.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2015
                09 December 2015
                : 11
                : 1817-1818
                Affiliations
                [1 ]Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar
                [2 ]Weill Cornell Medical College-Qatar, Al Rayyan, Qatar
                [3 ]School of Pharmacy, Lebanese International University, Khiara, Lebanon
                Author notes
                Correspondence: Mohamed Ata Hendaus, Department of Pediatrics, Academic General Pediatrics Division, Hamad Medical Corporation, Doha 3050, Qatar, Tel +974 44 392 239, Fax +974 44 439 571, Email mhendaus@ 123456yahoo.com
                Article
                tcrm-11-1817
                10.2147/TCRM.S96222
                4677756
                © 2015 Hendaus et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Medicine

                pneumonia, children, lung ultrasound

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