title: Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children: A Randomized Controlled Trial.
abstract: BACKGROUND
  Chest radiography (CXR) is the test of choice for diagnosing pneumonia. Lung ultrasonography (LUS) has been shown to be accurate for diagnosing pneumonia in children and may be an alternative to CXR. Our objective was to determine the feasibility and safety of substituting LUS for CXR when evaluating children suspected of having pneumonia.
  
  
  METHODS
  We conducted a randomized control trial comparing LUS with CXR in 191 children from birth to 21 years of age suspected of having pneumonia in an ED. Patients in the investigational arm underwent LUS. If there was clinical uncertainty after ultrasonography, physicians had the option to perform CXR. Patients in the control arm underwent sequential imaging with CXR followed by LUS. The primary outcome was the rate of CXR reduction; secondary outcomes were missed pneumonia, subsequent unscheduled health-care visits, and adverse events between the investigational and control arms.
  
  
  RESULTS
  There was a 38.8% reduction (95% CI, 30.0%-48.9%) in CXR among investigational subjects compared with no reduction (95% CI, 0.0%-3.6%) in the control group. Novice and experienced physician-sonologists achieved 30.0% and 60.6% reduction in CXR use, respectively. There were no cases of missed pneumonia among all study participants (investigational arm, 0.0%: 95% CI, 0.0%-2.9%; control arm, 0.0%: 95% CI, 0.0%-3.0%), or differences in adverse events, or subsequent unscheduled health-care visits between arms.
  
  
  CONCLUSIONS
  It may be feasible and safe to substitute LUS for CXR when evaluating children suspected of having pneumonia with no missed cases of pneumonia or increase in rates of adverse events.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT01654887; URL: www.clinicaltrials.gov.
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Brittany Pardue
authors.initials: BP
authors.lastname: Jones
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Emergency Ultrasound, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ee Tein
authors.initials: ET
authors.lastname: Tay
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Inna
authors.initials: I
authors.lastname: Elikashvili
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Sanders
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Audrey Z
authors.initials: AZ
authors.lastname: Paul
authors.affiliation: Division of Emergency Ultrasound, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Bret P
authors.initials: BP
authors.lastname: Nelson
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Spina
authors.affiliation: Division of Pediatric Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Emergency Ultrasound, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: jtsung@gmail.com.
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
mesh_terms: D000293:Adolescent; D002675:Child, Preschool; D005240:Feasibility Studies; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging*; D061214:Patient Safety; D011014:Pneumonia / Q000175:diagnosis*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: chest radiography; emergency medicine; lung ultrasound; pediatrics; pneumonia