Diagnostic Performance of Comprehensive Point-of-Care Ultrasound for Pediatric Tuberculosis in Spain: A Prospective Observational Study
Por:
Munyangaju I, Noguera-Julian A, Soler-García a, Soriano-Arandes A, Fernández JME, Espiau M, Garcia BS, Hernanz-Lobo A, Zapata ÁML, Enrique Ladera Gonzalez, Manzanares A, Blazquez D, Pascual EA, Thierry-Chef I, Buonsenso D, Serres-Créixams X, Bassat Q and Lopez-Varela E
Publicada:
1 jul 2026
Ahead of Print:
1 mar 2026
Resumen:
Background Diagnosing tuberculosis (TB) in children is challenging because of nonspecific symptoms, low microbiological yield, and imaging limitations. Comprehensive point-of-care ultrasound (cPOCUS) may detect mediastinal lymphadenopathy, but evidence remains limited.Methods We conducted a prospective observational study in four tertiary hospitals in Spain (May 2023-June 2024) enrolling children (0-18 years) with presumptive TB. All participants underwent chest X-ray (CXR) and cPOCUS; chest CT was performed when clinically indicated. cPOCUS assessed lung, mediastinal, and abdominal compartments using a standardized protocol. Images were independently reviewed by expert readers blinded to clinical data. Diagnostic performance was evaluated against a final TB classification based on clinical, immunological, microbiological, and conventional radiological findings, excluding cPOCUS.Results Twenty-seven children were included (median age 9.0 years), of whom 12 (44.4%) had TB disease. CT was performed in 14 (51.9%). Only 22.2% of cPOCUS examinations were complete. Mediastinal lymphadenopathy was the most frequent abnormality. cPOCUS detected abnormalities in 58.3%-63.6% of TB cases, particularly aortopulmonary window lymph nodes and small subpleural consolidations, with moderate sensitivity and high specificity (80.0%-86.7%). Inter-reader agreement was high (kappa = 0.92).Conclusions In this pilot prospective study, cPOCUS demonstrated limited diagnostic performance but high inter-reader reliability. These exploratory findings suggest that cPOCUS may complement standard imaging for selected abnormalities (particularly aortopulmonary window lymphadenopathy), but larger studies with optimized protocols are needed before broader clinical implementation.
Filiaciones:
Munyangaju I:
Barcelona Institute for Global Health - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
Nucleo de Pesquisa Pediatria, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
Noguera-Julian A:
Malalties Infeccioses I Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses I Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
Red de Investigación Translacional en Infectología Pediátrica RITIP, Madrid, Spain
Soler-García a:
Malalties Infeccioses I Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses I Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
Soriano-Arandes A:
Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria (UPIIP), Hospital Universitari Vall d'Hebron, Barcelona, Spain
Vall d'Hebron Research Institute, Infection and Immunity in Children, Barcelona, Spain
Fernández JME:
Radiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
Espiau M:
Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria (UPIIP), Hospital Universitari Vall d'Hebron, Barcelona, Spain
Garcia BS:
Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain
Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
Hernanz-Lobo A:
Red de Investigación Translacional en Infectología Pediátrica RITIP, Madrid, Spain
Pediatric Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain
Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
Zapata ÁML:
Gregorio Marañón Health Research Institute (IiSGM), Madrid, Spain
Pediatric Radiology, Gregorio Marañon University General Hospital, Madrid, Spain
Enrique Ladera Gonzalez:
Radiologia Pediàtrica, Hospital Sant Joan de Déu, Barcelona, Spain
Manzanares A:
Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
Blazquez D:
Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
Pascual EA:
Radiologia Pediàtrica, Hospital Universitario 12 de Octubre, Madrid, Spain
Thierry-Chef I:
Barcelona Institute for Global Health - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, Madrid, Spain
Universitat Pompeu Fabra (UPF), Barcelona, Spain
The French Authority for Nuclear Safety and Radiation Protection, Fontenay-aux-Roses cedex, France
Buonsenso D:
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Area Pediatrica, Dipartimento di Scienze della Vita a Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
Serres-Créixams X:
Radiodiagnóstico, Ecografia intervencionista, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Bassat Q:
Barcelona Institute for Global Health - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, Madrid, Spain
Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Mozambique
ICREA, Barcelona, Spain
Departament de Pediatria, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
Lopez-Varela E:
Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
Green Submitted, hybrid
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