title: Prospective evaluation of clinical lung ultrasonography in the diagnosis of community-acquired pneumonia in a pediatric emergency department.
abstract: OBJECTIVE
  To evaluate the applicability and utility of point-of-care lung ultrasonography (POCLUS) for the diagnosis of community-acquired pneumonia (CAP) in a pediatric emergency department.
  
  
  METHODS
  A prospective observational study on children with suspected CAP was carried out in a pediatric emergency department from August to December 2014. The evaluation of the chest radiography (CR) by two independent radiologists was considered as a reference standard. POCLUS was performed by pediatricians who were blinded to CR results. Following the WHO criteria, typical CAP was defined as an alveolar consolidation or infiltrate in CR and a visualization of lung consolidation with sonographic air bronchograms in POCLUS. The diagnostic accuracy of POCLUS (sensitivity, specificity, positive, and negative predictive values) was established using CR as a gold standard.
  
  
  RESULTS
  We enrolled 200 children with a median age of 29.5 months (interquartile range, 18.5-52.5); 58.1% were males and 42.0% had focal decreased breath sounds and/or crackles. The prevalence of typical CAP according to the radiologist's evaluation was 42.5% (end-point consolidation and/or pleural effusion 56.5%, alveolar infiltrate 43.5%). The sensitivity and specificity of POCLUS were 87.1% [95% confidence interval (CI) 78.0-93.4] and 94.8% (95% CI 89.0-98.1), respectively. The positive and negative predictive values were 92.5% (95% CI 84.4-97.2) and 90.8% (95% CI 84.2-95.3), respectively.
  
  
  CONCLUSIONS
  POCLUS performed by an emergency pediatrician with a limited experience in ultrasonography enables the diagnosis of pneumonia with high accuracy. POCLUS could become a feasible and promising alternative to CR in the diagnosis of suspected CAP, leading to a relevant decrease in children's exposure to ionizing radiations. Further studies specifically carried out in the pediatric outpatient setting are needed.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Samson
authors.affiliation: Research Unit REDISSEC.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Gorostiza
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics.
authors.forename: Andrés
authors.initials: A
authors.lastname: González
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics.
authors.forename: María
authors.initials: M
authors.lastname: Landa
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics.
authors.forename: Lucía
authors.initials: L
authors.lastname: Ruiz
authors.affiliation: Radiology Emergency Unit, Department of Radiology, Basurto University Hospital, Bilbao, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Grau
mesh_terms: D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014463:Ultrasonography