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Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze.
Emerg Med J. 2016 Sep; 33(9):603-10.EM

Abstract

OBJECTIVE

Characterise lung ultrasound (LUS) findings, diagnostic accuracy and agreement between novice and expert interpretations in young children with respiratory tract infections and wheeze.

METHODS

Prospective cross-sectional study in a paediatric ED. Patients ≤2 years with a respiratory tract infection and wheeze at triage were recruited unless in severe respiratory distress. Prior to clinical management, a novice sonologist performed the LUS using a six-zone scanning protocol. The treating physician remained blinded to ultrasound findings; final diagnoses were extracted from the medical record. An expert sonologist, blinded to all clinical information, assessed the ultrasound video clips at study completion. Positive LUS was defined as the presence of ≥1 of the following findings: ≥3 B-lines per intercostal space, consolidation and/or pleural abnormalities.

RESULTS

Ninety-four patients were enrolled (median age 11.1 months). LUS was positive in 42% (39/94) of patients (multiple B-lines in 80%, consolidation in 64%, pleural abnormalities in 23%). The proportion of positive LUS, along with their diagnostic accuracy (sensitivity (95% CI), specificity (95% CI)), were as follows for children with bronchiolitis, asthma, pneumonia and asthma/pneumonia: 46% (45.8% (34.0% to 58.0%), 72.7% (49.8% to 89.3%)), 0% (0% (0.0% to 23.3%), 51.3% (39.8% to 62.6%)), 100% (100% (39.8% to 100.0%), 61.1% (50.3% to 71.2%)), 50% (50% (6.8% to 93.2%), 58.9% (48.0% to 69.2%)), respectively. There was good agreement between the novice and expert sonographers for a positive LUS (kappa 0.68 (95% CI 0.54 to 0.82)).

CONCLUSIONS

Among children with respiratory tract infections and wheeze, a positive LUS seems to distinguish between clinical syndromes by ruling in pneumonia and ruling out asthma. If confirmed in future studies, LUS may emerge as a point-of-care tool to guide diagnosis and disposition in young children with wheeze.

Authors+Show Affiliations

Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.Department of Pediatric Respirology, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada Departments of Pediatrics, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada Department of Pediatric Emergency Medicine, Montreal Children's Hospital-McGill University Health Center, Montreal, Quebec, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27107052

Citation

Varshney, Terry, et al. "Point-of-care Lung Ultrasound in Young Children With Respiratory Tract Infections and Wheeze." Emergency Medicine Journal : EMJ, vol. 33, no. 9, 2016, pp. 603-10.
Varshney T, Mok E, Shapiro AJ, et al. Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze. Emerg Med J. 2016;33(9):603-10.
Varshney, T., Mok, E., Shapiro, A. J., Li, P., & Dubrovsky, A. S. (2016). Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze. Emergency Medicine Journal : EMJ, 33(9), 603-10. https://doi.org/10.1136/emermed-2015-205302
Varshney T, et al. Point-of-care Lung Ultrasound in Young Children With Respiratory Tract Infections and Wheeze. Emerg Med J. 2016;33(9):603-10. PubMed PMID: 27107052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze. AU - Varshney,Terry, AU - Mok,Elise, AU - Shapiro,Adam J, AU - Li,Patricia, AU - Dubrovsky,Alexander S, Y1 - 2016/04/22/ PY - 2015/08/11/received PY - 2016/03/25/accepted PY - 2016/4/24/entrez PY - 2016/4/24/pubmed PY - 2017/1/31/medline KW - asthma KW - infectious diseases, viral KW - paediatrics, paediatric emergency medicine KW - pneumonia/infections KW - ultrasound SP - 603 EP - 10 JF - Emergency medicine journal : EMJ JO - Emerg Med J VL - 33 IS - 9 N2 - OBJECTIVE: Characterise lung ultrasound (LUS) findings, diagnostic accuracy and agreement between novice and expert interpretations in young children with respiratory tract infections and wheeze. METHODS: Prospective cross-sectional study in a paediatric ED. Patients ≤2 years with a respiratory tract infection and wheeze at triage were recruited unless in severe respiratory distress. Prior to clinical management, a novice sonologist performed the LUS using a six-zone scanning protocol. The treating physician remained blinded to ultrasound findings; final diagnoses were extracted from the medical record. An expert sonologist, blinded to all clinical information, assessed the ultrasound video clips at study completion. Positive LUS was defined as the presence of ≥1 of the following findings: ≥3 B-lines per intercostal space, consolidation and/or pleural abnormalities. RESULTS: Ninety-four patients were enrolled (median age 11.1 months). LUS was positive in 42% (39/94) of patients (multiple B-lines in 80%, consolidation in 64%, pleural abnormalities in 23%). The proportion of positive LUS, along with their diagnostic accuracy (sensitivity (95% CI), specificity (95% CI)), were as follows for children with bronchiolitis, asthma, pneumonia and asthma/pneumonia: 46% (45.8% (34.0% to 58.0%), 72.7% (49.8% to 89.3%)), 0% (0% (0.0% to 23.3%), 51.3% (39.8% to 62.6%)), 100% (100% (39.8% to 100.0%), 61.1% (50.3% to 71.2%)), 50% (50% (6.8% to 93.2%), 58.9% (48.0% to 69.2%)), respectively. There was good agreement between the novice and expert sonographers for a positive LUS (kappa 0.68 (95% CI 0.54 to 0.82)). CONCLUSIONS: Among children with respiratory tract infections and wheeze, a positive LUS seems to distinguish between clinical syndromes by ruling in pneumonia and ruling out asthma. If confirmed in future studies, LUS may emerge as a point-of-care tool to guide diagnosis and disposition in young children with wheeze. SN - 1472-0213 UR - https://www.unboundmedicine.com/medline/citation/27107052/Point_of_care_lung_ultrasound_in_young_children_with_respiratory_tract_infections_and_wheeze_ L2 - http://emj.bmj.com/cgi/pmidlookup?view=long&pmid=27107052 DB - PRIME DP - Unbound Medicine ER -