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).


CONCLUSIONS
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.


BACKGROUND
The diagnosis of pneumonia is mainly based on physical examination plus radiologic and laboratory evaluation when needed. Although lung ultrasound (LUS) has shown high sensitivity in detecting several pleuropulmonary diseases in adults, its role in the work-up of pneumonia in children is not yet widely recognized.


BACKGROUND
LUS is confirmed to be a reliable imaging technique for the diagnostic work-up of febrile children with respiratory distress, consistent not only with CXR results as previously reported by others but also with clinical and laboratory data. In the hands of trained clinicians, it may represent a valuable supplemental bedside tool for a rapid evaluation in such circumstances.
Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy. mattia-guerra@libero.it.|Doctoral School in Sciences of Reproduction and Development, University of Trieste, Trieste, Italy. mattia-guerra@libero.it.
Mattia
M
Guerra
Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy. crichiutti.giovanni@aoud.sanita.fvg.it.
Giovanni
G
Crichiutti
Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy. pecilepaolo@gmail.com.
Paolo
P
Pecile
Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy. carla.romanello@gmail.com.
Carla
C
Romanello
Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy. busolini.eva@aoud.sanita.fvg.it.
Eva
E
Busolini
Institute of Hygiene and Clinical Epidemiology, University Hospital and Epidemiological Service of Udine, Regione Friuli Venezia Giulia, Udine, Italy. francesca.valent@regione.fvg.it.
Francesca
F
Valent
Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy. rosolen.angelo@aoud.sanita.fvg.it.|Department of Paediatrics, University of Padova, Padova, Italy. rosolen.angelo@aoud.sanita.fvg.it.
Angelo
A
Rosolen
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging*; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D011859:Radiography; D014463:Ultrasonography
Chest X-ray; Lung consolidation; Lung ultrasound; Paediatrician