Lung ultrasound patterns in paediatric pneumonia in Mozambique and Pakistan
Por:
Ginsburg AS, Vitorino P, Qasim Z, Lenahan JL, Hwang J, Lamorte A, Valente M, Balouch B, Munoz-Almagro C, Nisar MI, May S, Jehan F, Bassat Q and Volpicelli G
Publicada:
1 ene 2021
Ahead of Print:
1 feb 2021
Resumen:
Objective: Improved pneumonia diagnostics are needed, particularly in resource-constrained settings. Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing pneumonia. The objective was to explore LUS patterns associated with paediatric pneumonia.
Methods: We conducted a prospective, observational study among children aged 2 to 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at two district hospitals in Mozambique and Pakistan. We assessed LUS and chest radiograph (CXR) examinations, and viral and bacterial nasopharyngeal carriage, and performed a secondary analysis of LUS patterns.
Results: LUS demonstrated a range of distinctive patterns that differed between children with and without pneumonia and between children in Mozambique versus Pakistan. The presence of LUS consolidation or interstitial patterns was more common in children with chest-indrawing pneumonia than in those without pneumonia. Consolidations were also more common among those with only bacterial but no viral carriage detected (50.0%) than among those with both (13.0%) and those with only virus detected (8.3%; p=0.03). LUS showed high interrater reliability among expert LUS interpreters for overall determination of pneumonia (kappa=0.915), consolidation (kappa=0.915) and interstitial patterns (kappa=0.901), but interrater reliability between LUS and CXR for detecting consolidations was poor (kappa=0.159, Pakistan) to fair (kappa=0.453, Mozambique).
Discussion: Pattern recognition was discordant between LUS and CXR imaging modalities. Further research is needed to define and standardise LUS patterns associated with paediatric pneumonia and to evaluate the potential value of LUS as a reference standard.
Filiaciones:
Ginsburg AS:
Dept of Biostatistics, University of Washington, Seattle, WA, USA
Vitorino P:
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
Qasim Z:
Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Lenahan JL:
Save the Children Federation, Inc., Seattle, WA, USA
Hwang J:
Dept of Biostatistics, University of Washington, Seattle, WA, USA
Lamorte A:
Dept of Emergency Medicine, Parini Hospital, Aosta, Italy
Valente M:
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
Balouch B:
Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Munoz-Almagro C:
Instituto de Recerca Pediatrica, Hospital Sant Joan de Déu, Barcelona, Spain
Nisar MI:
Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
May S:
Dept of Biostatistics, University of Washington, Seattle, WA, USA
Jehan F:
Dept of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
Bassat Q:
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
Instituto de Recerca Pediatrica, Hospital Sant Joan de Déu, Barcelona, Spain
ICREA, Barcelona, Spain
Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Volpicelli G:
Dept of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy
Green Submitted, gold
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