Point-of-care lung ultrasound in children with non-cardiac respiratory distress or tachypnea

Am J Emerg Med. 2019 Nov;37(11):2102-2106. doi: 10.1016/j.ajem.2019.05.063. Epub 2019 Jun 3.

Abstract

Objective: The purpose of this study was to evaluate the feasibility and diagnostic benefit of point-of-care ultrasound (PoCLUS) in children with non-cardiac respiratory distress or tachypnea.

Methods: In this prospective observational study, children aged between 1 month and 18 years with respiratory distress, tachypnea, or both, at triage were included. Concordance and accuracy of the emergency department (ED) and ultrasound diagnoses, length of stay, and time elapsing until ED and ultrasound diagnoses were calculated.

Results: One hundred forty-five patients were evaluated. The mean age of the children in the study was 67 ± 58 months. Seventy-nine patients (56%) were boys. Mean length of stay in the ED was 124.6 ± 76.5 min. Mean time to ultrasound diagnosis was 29.32 ± 15.71 min, compared to 46.75 ± 32.65 min for ED diagnosis, which was significantly longer (p < 0.001). Concordance between ultrasound and ED diagnoses was almost perfect for pneumonia, acute bronchiolitis, asthma and croup (0.8 < Ƙ < 1), and good for other non-pulmonary causes (0.6 < Ƙ < 0.8). Overall concordance for all diagnoses was also good (Ƙ = 0.76). Ultrasound diagnosis was more sensitive than ED diagnosis for pneumonia, acute bronchiolitis, and other non-pulmonary causes (81.4%-74.42%; 97.3%-86.49%; and 100%-95.83%, respectively). In addition, ultrasound diagnosis was more specific than ED diagnosis for pneumonia, acute bronchiolitis and other non-pulmonary causes (100%-97.35%; 99.07%-98.15%; and 93.39%-88.43%, respectively). However, ultrasound and ED diagnoses exhibited similar sensitivity and specificity values for asthma (97.22%-97.22%; and 99.08%-100%).

Conclusion: PoCLUS may constitute a beneficial and rational approach in the evaluation of children with increased work of breathing in the ED, and can also expedite the diagnostic process.

Keywords: Children; Lung ultrasound; PoCLUS; Respiratory distress; Tachypnea.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Emergency Service, Hospital
  • Feasibility Studies
  • Female
  • Humans
  • Infant
  • Lung / diagnostic imaging*
  • Male
  • Point-of-Care Systems*
  • Prospective Studies
  • Respiratory Insufficiency / diagnostic imaging*
  • Sensitivity and Specificity
  • Tachypnea / diagnostic imaging*
  • Ultrasonography