Lung ultrasound for paediatric pneumonia

Q. Can Lung ultrasound reduce need for CXR in children with suspected pneumonia?

Jones BP, Tay ET, Elikashvili I, et al. Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest 2016;150(1):131-138.

• randomized 191 children and adolescents with clinically suspected pneumonia to receive either CXR always followed by lung ultrasound (LUS)
• The median patient age was 3 years, and cough, difficulty breathing and fever were the most common symptoms.
• lung ultrasound was highly accurate for diagnosing pneumonia in children (96% sensitive, 93% specific, positive likelihood ratio = 15, negative likelihood ratio = .06).
• Patients in the initial LUS group had fewer CXRs, with 40 of 103 patients not receiving one (NNT = 2.5 to prevent one CXR)
• There was also no difference in unscheduled healthcare visits or antibiotic use, and there was a nonsignificant 27-minute reduction in emergency department stay in the initial LUS group. Results looked even better with more experienced sonologists.

A. Handheld ultrasound is making its way into clinical practice, and this study shows that it can safely reduce the use of chest radiography (CXR) in children with clinically suspected pneumonia and may make care more efficient.