Ultrasound detection of pneumonia in febrile children with respiratory distress: a prospective study

To analyse the usefulness of bedside lung ultrasound (LUS) in detecting lung consolidation in a paediatric emergency room (ER) setting, febrile children seen at our ER from 2008 to 2012 with a moderate to severe respiratory distress underwent LUS, chest X-ray (CXR) and laboratory investigations. At first ER assessment, LUS identified a lung consolidation in 207 patients of 222 children enrolled, with a liver-like appearance in 75 (36.2 %) and an associated pleural effusion in 36.7 % of cases. CXR proved positive in 197 cases, showing a parenchymal consolidation (68.5 %) or a focal ground-glass opacity (31.4 %). LUS liver-like consolidation was significantly associated with longer duration of fever (p = 0.002), higher neutrophil counts and C-reactive protein (CRP) values (p = 0.015 and p < 0.0001, respectively), and with the discovery of a homogeneous and dense parenchymal consolidation on CXR (p < 0.0001). Conclusion: LUS can be adopted by the clinician as a non-invasive bedside tool to expand the physical evaluation of febrile children with respiratory distress. In our study, LUS results appeared not only as reliable as CXR in detecting lung consolidations but also consistent with clinical and laboratory data.