title: Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults.
abstract: OBJECTIVE
  To determine the accuracy of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults by a group of clinicians.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Two urban emergency departments.
  
  
  METHODS
  Patients from birth to age 21 years undergoing chest radiography for suspected community-acquired pneumonia.
  
  
  METHODS
  After documenting clinical examination findings, clinicians with 1 hour of focused training used ultrasonography to diagnose pneumonia in children and young adults.
  
  
  METHODS
  Test performance characteristics for the ability of ultrasonography to diagnose pneumonia were determined using chest radiography as a reference standard. Subgroup analysis was performed in patients having lung consolidation exceeding 1 cm with sonographic air bronchograms detected on ultrasonography; specificity and positive likelihood ratio (LR) were calculated to account for lung consolidation of 1 cm or less with sonographic air bronchograms undetectable by chest radiography.
  
  
  RESULTS
  Two hundred patients were studied (median age, 3 years; interquartile range, 1-8 years); 56.0% were male, and the prevalence of pneumonia by chest radiography was 18.0%. Ultrasonography had an overall sensitivity of 86% (95% CI, 71%-94%), specificity of 89% (95% CI, 83%-93%), positive LR of 7.8 (95% CI, 5.0-12.4), and negative LR of 0.2 (95% CI, 0.1-0.4) for diagnosing pneumonia by visualizing lung consolidation with sonographic air bronchograms. In subgroup analysis of 187 patients having lung consolidation exceeding 1 cm, ultrasonography had a sensitivity of 86% (95% CI, 71%-94%), specificity of 97% (95% CI, 93%-99%), positive LR of 28.2 (95% CI, 11.8-67.6) and negative LR of 0.1 (95% CI, 0.1-0.3) for diagnosing pneumonia.
  
  
  CONCLUSIONS
  Clinicians are able to diagnose pneumonia in children and young adults using point-of-care ultrasonography, with high specificity.
authors.affiliation: Department of Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Vaishali P
authors.initials: VP
authors.lastname: Shah
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016013:Likelihood Functions; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D055815:Young Adult