title: Point of care lung ultrasound of children with acute asthma exacerbations in the pediatric ED.
abstract: OBJECTIVE
  Primary objective was to characterize lung ultrasound findings in children with asthma presenting with respiratory distress to the emergency department (ED). Secondary objectives included correlating these findings with patients' clinical course in the ED.
  
  
  METHODS
  Eligible patients 2-17years of age, underwent a lung ultrasound by the study sonographer between November 2014 to December 2015. Positive lung ultrasound was defined as the presence of ≥1 of the following findings: ≥3 B-lines per intercostal space, consolidation and/or pleural abnormalities. The treating physician remained blinded to ultrasound findings; clinical course was extracted from the medical chart.
  
  
  RESULTS
  A total of sixty patients were enrolled in this study. Lung ultrasound was positive in 45% (27/60) of patients: B-line pattern in 38%, consolidation in 30% and pleural line abnormalities in 12%. A positive lung ultrasound correlated with increased utilization of antibiotics (26% vs 0%, p=0.03), prolonged ED length of stay (30% vs. 9%, p=0.04) and admission rate (30% vs 0%, p=0.03). Inter-rater agreement between novice and expert sonographers was excellent with a kappa of 0.92 (95% CI: 0.84-1.00).
  
  
  CONCLUSIONS
  This study characterized lung ultrasound findings in pediatric patients presenting with acute asthma exacerbations; nearly half of whom had a positive lung ultrasound. Positive lung ultrasounds were associated with increased ED and hospital resource utilization. Future prospective studies are needed to determine the utility and reliability of this tool in clinical practice.
authors.affiliation: Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Samantha
authors.initials: S
authors.lastname: Dankoff
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Shapiro
authors.affiliation: Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Terry
authors.initials: T
authors.lastname: Varshney
authors.affiliation: Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: sasha.dubrovsky@mcgill.ca.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Dubrovsky
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001249:Asthma / Q000000981:diagnostic imaging* / Q000628:therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D010102:Oxygen Inhalation Therapy; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents