Lung Ultrasound May Be a Safe Substitute for Diagnosing Pneumonia in Children
Lung ultrasound has been shown to be highly effective and safe for diagnosing pneumonia in children and a potential substitute for chest X-ray, according to a study conducted at the Icahn School of Medicine at Mount Sinai and published in the medical journal Chest.
Pneumonia is the leading infectious cause of death in children worldwide, according to the World Health Organization (WHO). Symptoms include fever, cough, and rapid breathing. Chest X-ray is considered the test of choice for diagnosing pneumonia in children, but the WHO estimates roughly 70% of the world's population does not have access to radiography.
Investigators conducted a randomized controlled trial in the pediatric emergency department at the Mount Sinai Hospital comparing lung ultrasound with chest X-ray in 191 children from birth to age 21. The patients were randomly assigned into an investigational arm (received a lung ultrasound and, if the physician needed additional verification, a chest X-ray) and a control arm (received a chest X-ray followed by a lung ultrasound). Researchers found a 38.8% reduction in chest X-rays in the investigational arm, with no missed pneumonia cases and no increase in any other adverse events.
The research team was led by James Tsung, MD, MPH, an associate professor in the department of emergency medicine and department of pediatrics at the Icahn School of Medicine at Mount Sinai, and former clinical fellow Brittany Pardue Jones, MD, an assistant professor in the department of pediatrics at Vanderbilt University School of Medicine.
"Ultrasound is portable, cost saving, and safer for children than an X-ray because it does not expose them to radiation," Tsung says. "Our study could have a profound impact in the developing world where access to radiography is limited."
Furthermore, the reduction in chest X-rays in the investigational arm resulted in an overall cost savings of $9,200, and length of stay in the emergency department was decreased by 26 minutes.
"In the era of precision medicine, lung ultrasound may also be an ideal imaging option in children who are at higher risk for radiation-induced cancers or have received multiple radiographic or CT imaging studies," Tsung says.
As more and more handheld ultrasound machines come to market, these results suggest that lung ultrasound has the potential to become the preferred choice for the diagnosis of pneumonia in children. Further research is needed to investigate the impact of lung ultrasound on antibiotic use and stewardship.
Source: Mount Sinai Hospital
