Pediatric Lung Ultrasound (PLUS) in the diagnosis of Community-Acquired Pneumonia (CAP) requiring hospitalization

BACKGROUND: In childhood pneumonia, pediatric lung ultrasound (PLUS) is a very sensitive and specific diagnostic alternative to chest X-ray (CXR). However, there is a paucity of literature on this in India. We set out to compare the diagnostic accuracy of PLUS and CXR in hospitalized children with community-acquired pneumonia (CAP). SETTING AND DESIGN: Prospective, observational study (June 2017–September 2019) at a tertiary care hospital. METHODS: Hospitalized children of CAP (3 months–18 years) were included after taking informed, written consent. Hemodynamic instability, asthma, cystic fibrosis, congenital heart disease, immunodeficiency, and malignancy cases were excluded. CXR (frontal view) and PLUS were done within 6 h of each other and within 24 h of hospitalization. Statistical analysis was performed using SPSS software version 25. RESULTS: Out of 612 consecutive, hospitalized respiratory cases, 261 were recruited. CAP was diagnosed clinically in 148 (56.7%) patients [95 boys (64.19%), mean age in years ± SDL: 4.31 ± 4.41]. Abnormal PLUS was present in 141 (95.27%) and abnormal CXR in 128 (86.48%) patients. In radiologically diagnosed pneumonia, PLUS was detected in 123 [123/128 (96.09%)] children, and when CXR was normal, PLUS was abnormal in 18 [18/20 (90%)]. PLUS showed a sensitivity of 95.27% (95% CI: 90.50–98.08) and a specificity of 92.90% (95% CI: 86.53–96.89). CXR showed a sensitivity of 86.49% (95% CI: 79.9–91.55) and a specificity of 90.27% (95% CI: 83.25–95.04). CONCLUSIONS: PLUS is a sensitive, specific test and can be considered as the preferred investigation before CXR in children hospitalized with CAP.