title: Lung ultrasound in the diagnosis of pneumonia in children: proposal for a new diagnostic algorithm.
abstract: Background. Despite guideline recommendations, chest radiography (CR) for the diagnosis of community-acquired pneumonia (CAP) in children is commonly used also in mild and/or uncomplicated cases. The aim of this study is to assess the reliability of lung ultrasonography (LUS) as an alternative test in these cases and suggest a new diagnostic algorithm. Methods. We reviewed the medical records of all patients admitted to the pediatric ward from February 1, 2013 to December 31, 2014 with respiratory signs and symptoms. We selected only cases with mild/uncomplicated clinical course and in which CR and LUS were performed within 24 h of each other. The LUS was not part of the required exams recorded in medical records but performed independently. The discharge diagnosis, made only on the basis of history and physical examination, laboratory and instrumental tests, including CR (without LUS), was used as a reference test to compare CR and LUS findings. Results. Of 52 selected medical records CAP diagnosis was confirmed in 29 (55.7%). CR was positive in 25 cases, whereas LUS detected pneumonia in 28 cases. Four patients with negative CR were positive in ultrasound findings. Instead, one patient with negative LUS was positive in radiographic findings. The LUS sensitivity was 96.5% (95% CI [82.2%-99.9%]), specificity of 95.6% (95% CI [78.0%-99.9%]), positive likelihood ratio of 22.2 (95% CI [3.2-151.2]), and negative likelihood ratio of 0.04 (95% CI [0.01-0.25]) for diagnosing pneumonia. Conclusion. LUS can be considered as a valid alternative diagnostic tool of CAP in children and its use must be promoted as a first approach in accordance with our new diagnostic algorithm.
authors.affiliation: Department of Pediatrics, San Giovanni di Dio Hospital, Azienda Sanitaria Locale Napoli 2 Nord , Frattamaggiore (NA) , Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Iorio
authors.affiliation: District 18, Azienda Sanitaria Locale Caserta , Sant'Arpino (CE) , Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Capasso
authors.affiliation: Department of Pediatrics, San Giovanni di Dio Hospital, Azienda Sanitaria Locale Napoli 2 Nord , Frattamaggiore (NA) , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.affiliation: Department of Pediatrics, San Giovanni di Dio Hospital, Azienda Sanitaria Locale Napoli 2 Nord , Frattamaggiore (NA) , Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Prisco
authors.affiliation: Department of Pediatrics, San Giovanni di Dio Hospital, Azienda Sanitaria Locale Napoli 2 Nord , Frattamaggiore (NA) , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mancusi
authors.affiliation: Department of Pediatrics, San Giovanni di Dio Hospital, Azienda Sanitaria Locale Napoli 2 Nord , Frattamaggiore (NA) , Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Laganà
authors.affiliation: Department of Pediatrics, San Giovanni di Dio Hospital, Azienda Sanitaria Locale Napoli 2 Nord , Frattamaggiore (NA) , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Comune
keywords: Chest radiography; Community-acquired pneumonia; Lung ultrasonography; Lung ultrasound; Pneumonia