title: Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis.
abstract: OBJECTIVE
  Pneumonia is the leading cause of death of children. Diagnostic tools include chest radiography, but guidelines do not currently recommend the use of lung ultrasound (LUS) as a diagnostic method. We conducted a meta-analysis to summarize evidence on the diagnostic accuracy of LUS for childhood pneumonia.
  
  
  METHODS
  We performed a systematic search in PubMed, Embase, the Cochrane Library, Scopus, Global Health, World Health Organization-Libraries, and Latin American and Caribbean Health Sciences Literature of studies comparing LUS diagnostic accuracy against a reference standard. We used a combination of controlled key words for age <18 years, pneumonia, and ultrasound. We identified 1475 studies and selected 15 (1%) for further review. Eight studies (765 children) were retrieved for analysis, of which 6 (75%) were conducted in the general pediatric population and 2 (25%) in neonates. Eligible studies provided information to calculate sensitivity, specificity, and positive and negative likelihood ratios. Heterogeneity was assessed by using Q and I(2) statistics.
  
  
  RESULTS
  Five studies (63%) reported using highly skilled sonographers. Overall methodologic quality was high, but heterogeneity was observed across studies. LUS had a sensitivity of 96% (95% confidence interval [CI]: 94%-97%) and specificity of 93% (95% CI: 90%-96%), and positive and negative likelihood ratios were 15.3 (95% CI: 6.6-35.3) and 0.06 (95% CI: 0.03-0.11), respectively. The area under the receiver operating characteristic curve was 0.98. Limitations included the following: most studies included in our analysis had a low number of patients, and the number of eligible studies was also small.
  
  
  CONCLUSIONS
  Current evidence supports LUS as an imaging alternative for the diagnosis of childhood pneumonia. Recommendations to train pediatricians on LUS for diagnosis of pneumonia may have important implications in different clinical settings.
authors.affiliation: Division of Pulmonary and Critical Care and.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Pereda
authors.affiliation: Division of Pulmonary and Critical Care and Biomedical Research Unit, A.B. Prisma, Lima, Peru;
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Chavez
authors.affiliation: Division of Pulmonary and Critical Care and.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Hooper-Miele
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland;
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Global Child Health Center, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Steinhoff
authors.affiliation: Division of Pulmonary and Critical Care and.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Ellington
authors.affiliation: Welch Medical Library, School of Medicine, and.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gross
authors.affiliation: Welch Medical Library, School of Medicine, and.
authors.forename: Carrie
authors.initials: C
authors.lastname: Price
authors.affiliation: Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
authors.affiliation: Division of Pulmonary and Critical Care and Biomedical Research Unit, A.B. Prisma, Lima, Peru; Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; wcheckl1@jhmi.edu.
authors.forename: William
authors.initials: W
authors.lastname: Checkley
mesh_terms: D002648:Child; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D011014:Pneumonia / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014481:United States
keywords: practice management; pulmonology; respiratory tract; standard of care