#EMconf: Ultrasound vs. CXR for Pediatric Pneumonia

Question: Is point-of-care lung ultrasound a better imaging study for diagnosing pediatric pneumonia than chest xray in the emergency department?

Lung ultrasound (LUS) has robust data for its ability to interpret pneumonia in both adults and children, which these two studies support. More studies are needed to show LUS’s superiority or comparability to chest x-ray (CXR). Moreover, LUS is still a learned skill that takes time, training, and clinician confidence in interpretation. Therefore, it is likely not ready for mainstream use and CXR should still be performed if pediatric pneumonia is suspected.


Source #1: Jones BP, Tay ET, Elikashvili I, et al. Feasibility and Safety of Substituting Lung Ultrasonography for Chest Radiography When Diagnosing Pneumonia in Children: A Randomized Controlled Trial. Chest. 2016;150(1):131-8.

       -RCT that compared lung ultrasound with chest x-ray in children from birth to 21 years of age suspected of having pneumonia
       -The primary outcome was rate of reduction of CXR
       - There was an overall 38.8% reduction in CXR among the investigational arm, with more experienced sonologists having a higher rate of reduction.

       -This was an RCT, the first of its kind, and had multiple sonographers/investigators in the study, reducing bias
       -However, this is a single center study and the gold standard (chest CT) was not utilized.


Source #2: Yilmaz HL, Özkaya AK, Sarı gökay S, Tolu kendir Ö, Şenol H. Point-of-care lung ultrasound in children with community acquired pneumonia. Am J Emerg Med. 2017;35(7):964-969.

       -Observational prospective study aimed to show the benefit of LUS in diagnosing pneumonia in comparison with CXR
       -Given this study’s methodology, overall percentage agreement (OPA), positive percentage agreement (PPA) and negative percentage agreement (NPA) were calculated and were 86.6%, 96.2% and 11.8% respectively

       -All patients had a CXR and LUS performed, which allows true comparison between groups
       -However there was only one sonographer in the study, which introduces bias
       -CXR was only AP films; adding lateral view increases the sensitivity of CXR for pneumonia