RT Journal Article
SR Electronic
T1 Lung ultrasound patterns in pediatric pneumonia in Mozambique and Pakistan
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00518-2020
DO 10.1183/23120541.00518-2020
A1 Amy Sarah Ginsburg
A1 Pio Vitorino
A1 Zunera Qasim
A1 Jennifer L. Lenahan
A1 Jun Hwang
A1 Alessandro Lamorte
A1 Marta Valente
A1 Benazir Balouch
A1 Carmen Muñoz Almagro
A1 M. Imran Nisar
A1 Susanne May
A1 Fyezah Jehan
A1 Quique Bassat
A1 Giovanni Volpicelli
YR 2020
UL http://openres.ersjournals.com/content/early/2020/11/06/23120541.00518-2020.abstract
AB Objective Improved pneumonia diagnostics are needed, particularly in resource-constrained settings. Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing pneumonia. The objective was to explore LUS patterns associated with pediatric pneumonia.Methods We conducted a prospective, observational study among children aged 2 through 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at two district hospitals in Mozambique and Pakistan. We assessed LUS and chest radiograph (CXR) examinations, and viral and bacterial nasopharyngeal carriage, and performed a secondary analysis of LUS patterns.Results LUS demonstrated a range of distinctive patterns that differed between children with and without pneumonia and between children in Mozambique versus Pakistan. The presence of LUS consolidation or interstitial patterns was more common in children with chest-indrawing pneumonia than in those without pneumonia. Consolidations were also more common among those with only bacterial but no viral carriage detected (50.0%) than among those with both (13.0%) and those with only virus detected (8.3%;p-value 0.03). LUS showed high interrater reliability among expert LUS interpreters for overall determination of pneumonia (κ=0.915), consolidation (κ=0.915), and interstitial patterns (κ=0.901), but interrater reliability between LUS and CXR for detecting consolidations was poor (κ=0.159, Pakistan) to fair (κ=0.453, Mozambique).Discussion Pattern recognition was discordant between LUS and CXR imaging modalities. Further research is needed to define and standardise LUS patterns associated with pediatric pneumonia and to evaluate the potential value of LUS as a reference standard.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Ginsburg reports grants from Bill & Melinda Gates Foundation during the conduct of the study.Conflict of interest: Dr. Vitorino has nothing to disclose.Conflict of interest: Dr. Qasim has nothing to disclose.Conflict of interest: Dr. Lenahan has nothing to disclose.Conflict of interest: Dr. Hwang has nothing to disclose.Conflict of interest: Dr. Lamorte has nothing to disclose.Conflict of interest: Dr. Valente has nothing to disclose.Conflict of interest: Dr. Balouch has nothing to disclose.Conflict of interest: Dr. Muñoz Almagro has nothing to disclose.Conflict of interest: Dr. Nisar has nothing to disclose.Conflict of interest: Dr. May reports grants from Bill & Melinda Gates Foundation, during the conduct of the study; and Publications are expected for my academic position. Academic audiences will be aware of this, but other audiences might not.Conflict of interest: Dr. Jehan has nothing to disclose.Conflict of interest: Dr. Bassat has nothing to disclose.Conflict of interest: Dr. Volpicelli has nothing to disclose.