Lung Ultrasound as First-Line Examination for the Diagnosis of Community-Acquired Pneumonia in Children

Objectives: The diagnosis of pediatric community-acquired pneumonia (CAP) is based on clinical criteria. Even though chest x-ray (CXR) is only recommended in severe cases, it is often requested from physicians in mild cases, thus increasing radiation exposure. Lung ultrasound (LUS) is not included in the diagnostic workup. The objective of this study was to evaluate the diagnostic performance of LUS against CXR. Methods: Children who presented to the emergency department with clinical signs suggesting CAP and had already been evaluated with a CXR were included in the study. Availability of a pediatric sonographer expert in LUS was also considered a criterion for participation. Chest x-ray and LUS were considered positive for CAP in cases of alveolar or interstitial pattern of disease. The diagnostic criterion standard was the ex post diagnosis of pneumonia, made by an independent senior expert pediatrician, after evaluation of the complete medical chart. Results: Sixty-nine children were enrolled in the study, with 66 of 69 positive for CAP. Receiver operating characteristic curve analysis results for CXR were 95.5% sensitivity and 100% specificity, whereas for LUS, sensitivity was reported 92.42% and specificity 100%. Comparison of the 2 receiver operating characteristic curves revealed no difference in the diagnostic value of the 2 methods for the diagnosis of pneumonia (P = 0.658). However, LUS classified more cases as alveolar disease compared with CXR. Conclusions: Lung ultrasound plays a significant role in the detection of CAP, not inferior to CXR. The aim of this study was to encourage the use of ultrasound as a first-line examination for CAP in children.