Lung ultrasound compared to chest X‐ray for diagnosis of pediatric pneumonia: A meta‐analysis

Lung ultrasound compared to chest X‐ray for diagnosis of pediatric pneumonia: A meta‐analysis

Objective Although a clinical diagnosis, the standard initial imaging modality for patients with concern for pediatric community acquired pneumonia (pCAP) is a chest x‐ray (CXR), which has a relatively high false negative rate, exposes patients to ionizing radiation, and may not be available in reso...

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Bibliographic Details
Published in:Pediatric pulmonology Vol. 53; no. 8; pp. 1130 - 1139
Main Authors: Balk, Daniel S., Lee, Christine, Schafer, Jesse, Welwarth, Jeremy, Hardin, John, Novack, Victor, Yarza, Shaked, Hoffmann, Beatrice
Format: Journal Article
Language:English
Published: United States Wiley Subscription Services, Inc 01-08-2018
Subjects:
Child
communicable diseases
Humans
Lung - diagnostic imaging
Meta-analysis
Pediatrics
Pneumonia
Pneumonia - diagnosis
Radiography, Thoracic
Sensitivity and Specificity
thoracic radiography
ultrasonic diagnosis
Ultrasonic imaging
ultrasonography
ultrasonic diagnosis
communicable diseases
pneumonia
ultrasonography
thoracic radiography
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Summary:Objective Although a clinical diagnosis, the standard initial imaging modality for patients with concern for pediatric community acquired pneumonia (pCAP) is a chest x‐ray (CXR), which has a relatively high false negative rate, exposes patients to ionizing radiation, and may not be available in resource limited settings. The primary objective of this meta‐analysis is to evaluate the accuracy of lung ultrasound (LUS) compared to CXR for the diagnosis of pCAP. Methods Data were collected via a systematic review of PubMed, EMBASE, and Web of Science with dates up to August 2017. Keywords and search terms were generated for pneumonia, lung ultrasound, and pediatric population. Two independent investigators screened s for inclusion. PRISMA was used for selecting appropriate studies. QUADAS was applied to these studies to assess quality for inclusion into the meta‐analysis. We collected data from included studies and calculated sensitivity, specificity, positive predictive value, and negative predictive values of CXR and LUS for the diagnosis of pCAP. Results Twelve studies including 1510 patients were selected for data extraction. LUS had a sensitivity of 95.5% (93.6‐97.1) and specificity of 95.3% (91.1‐98.3). CXR had a sensitivity of 86.8% (83.3‐90.0) and specificity of 98.2% (95.7‐99.6). Variations between the studies included ultrasound findings diagnostic of pneumonia, study setting (inpatient vs emergency department) and inclusion of CXR in the reference standard for pneumonia. Conclusions In our meta‐analysis, lung ultrasound had significantly better sensitivity with similar specificity when compared to chest x‐ray for the diagnosis of pediatric community acquired pneumonia.
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ISSN:8755-6863
1099-0496
DOI:10.1002/ppul.24020