The Utility of Bedside Lung Ultrasound Findings in Bronchiolitis.
OBJECTIVE
Recent literature suggests that bedside lung ultrasound may have a role in the evaluation of infants with bronchiolitis. B lines, which are multiple and diffuse vertical artifacts spreading from the lung pleural interface to the edge of the ultrasound screen, have been associated with thickened interlobular septa, extravascular lung water, and diffuse parenchymal disease. The aims of this study were (1) to describe the prevalence of B lines in children younger than 24 months presenting to the emergency department with wheezing, (2) to determine the interrater reliability of lung ultrasound findings in this setting, and (3) to determine the association of B lines with atopy and other clinical findings.


METHODS
This was a pilot, prospective, observational study of a convenience sample of patients younger than 2 years presenting with wheezing to a large academic pediatric hospital emergency department. Investigators performed lung ultrasound examinations, and a second provider reviewed the ultrasound examinations to determine interrater reliability. We performed univariate analyses to test for associations between ultrasound findings and atopy, acute illness severity, age, and treatment response.


RESULTS
Studies were obtained on 29 patients (mean [SD] age, 291 [187] days; 62% male). Twenty-one patients (72%) had compact B lines. B lines were significantly associated with older age and an absence of atopic features. There was poor correlation of lung ultrasound examination interpretation among enrolling providers.


CONCLUSIONS
In this small sample of patients with bronchiolitis, B lines were associated with older age and an absence of atopic features. Lung ultrasound interpretation had poor interrater reliability.
From the *Division of Emergency Medicine, Children's National Medical Center; †School of Medicine and Health Sciences, The George Washington University; ‡Center for Community and Clinical Research, Children's National Medical Center; and §Department of Emergency Medicine, The George Washington University Hospital, Washington, DC.
Joanna S
JS
Cohen
Naomi
N
Hughes
Sonny
S
Tat
James M
JM
Chamberlain
Stephen J
SJ
Teach
Keith
K
Boniface
D001988:Bronchiolitis / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung; D008297:Male; D019095:Point-of-Care Systems; D014463:Ultrasonography / Q000379:methods*