For Pediatric CAP, Lung Point-of-Care Ultrasonography May Be a Better Diagnostic Tool Than Chest Radiography

Compared with chest radiography, ultrasonography may help clinicians make a more accurate correlation between clinical findings of pneumonia and findings on diagnostic images, according to a new study.

In the study of 50 children who met the World Health Organization (WHO) definition of severe pneumonia, more children with pneumonia had normal findings on chest radiography films than on lung point-of-care ultrasonograms.

Previous studies determined that findings on chest radiography films poorly correlated with the WHO definition of severe pneumonia, and several studies have shown that lung point-of-care ultrasound imaging is more sensitive and specific than chest radiography for diagnosing pneumonia in children.

Children in whom WHO’s definition of severe pneumonia was met were enrolled in the study at a teaching hospital in Lusaka, Zambia, and received chest radiography as well as lung point-of-care ultrasonography imaging. The correlation between symptoms and abnormalities seen on both resulting images was analyzed by calculating the proportion of children with abnormalities on chest radiography films vs on ultrasonograms.

Whereas 44 children (90%) had abnormalities on chest radiography films, more children (46, or 94%) had abnormalities on ultrasonograms. Regarding normal findings, more children (5, or 10%) had them on chest radiography films than on ultrasonograms (3 children, or 6%).

According to the study’s principal investigator, Ingrid Camelo, MD, MPH, “The higher proportion of children diagnosed with consolidation and non-consolidation patterns on [point of care ultrasound] suggests that [chest x-ray] might not be the ideal gold standard to diagnose pneumonia in children.”

—Ellen Kurek

Camelo IY, Pieciak R, Castro-Aragon I, Setty B, Etter L, Gil C. Correlation between WHO (World Health Organization) case definition of severe pneumonia and lung POCUS (point of care ultrasound) vs chest x-ray (CXR) findings to diagnose pediatric community-acquired pneumonia (CAP) in limited resource settings. Paper presented at: IDWeek 2021; September 29–October 3, 2021; Virtual.