Can lung ultrasound differentiate between bacterial and viral pneumonia in children?

J Clin Ultrasound. 2021 Feb;49(2):91-100. doi: 10.1002/jcu.22951. Epub 2020 Nov 16.

Abstract

Purpose: This study evaluates whether LUS can differentiate between bacterial and viral pneumonia in children and thus affect their management.

Methods: The prospective, cross-sectional, analytical study included 200 children under 12 years of age (excluding neonates) with clinical suspicion of pneumonia who had undergone a chest radiograph (CR). The CR and LUS findings were classified as bacterial or viral pneumonia. The final diagnosis was made on the basis of a combination of clinical profile, available routine laboratory investigations and CR diagnosis which was taken as the gold standard for the study and LUS was compared with the gold standard.

Results: LUS has a high sensitivity (91%; 95% CI [84-96]) and specificity (91.3%; 95% CI [84-96]) in diagnosing bacterial pneumonia with a high positive predictive value (91.9%; 95% CI [85-96]) and negative predictive value (90.3%; 95% CI [82-95]). For diagnosing viral pneumonia, the sensitivity of LUS was 78.4%; (95% CI [68-86]), specificity was high (90.4%; 95% CI [83-95]) and so was the positive predictive value (87.3%; 95% CI [78-94]) and negative predictive value (91.3%; 95% CI [84-96]).

Conclusion: LUS has a high accuracy in differentiating between bacterial and viral pneumonia in children and can help in their management by avoiding an ill-advised use of antibiotic therapy.

Keywords: children; lung; pneumonia; ultrasound.

MeSH terms

  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Diagnosis, Differential
  • Female
  • Humans
  • Infant, Newborn
  • Laboratories
  • Male
  • Pneumonia, Bacterial / diagnostic imaging*
  • Pneumonia, Viral / diagnostic imaging*
  • Prospective Studies
  • Radiography
  • Sensitivity and Specificity
  • Ultrasonography