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Ultrasound detection of pneumonia in febrile children with respiratory distress: a prospective study

European Journal of Pediatrics volume 175, pages 163–170 (2016)Cite this article

Abstract

To analyse the usefulness of bedside lung ultrasound (LUS) in detecting lung consolidation in a paediatric emergency room (ER) setting, febrile children seen at our ER from 2008 to 2012 with a moderate to severe respiratory distress underwent LUS, chest X-ray (CXR) and laboratory investigations. At first ER assessment, LUS identified a lung consolidation in 207 patients of 222 children enrolled, with a liver-like appearance in 75 (36.2 %) and an associated pleural effusion in 36.7 % of cases. CXR proved positive in 197 cases, showing a parenchymal consolidation (68.5 %) or a focal ground-glass opacity (31.4 %). LUS liver-like consolidation was significantly associated with longer duration of fever (p = 0.002), higher neutrophil counts and C-reactive protein (CRP) values (p = 0.015 and p < 0.0001, respectively), and with the discovery of a homogeneous and dense parenchymal consolidation on CXR (p < 0.0001).

Conclusion: LUS can be adopted by the clinician as a non-invasive bedside tool to expand the physical evaluation of febrile children with respiratory distress. In our study, LUS results appeared not only as reliable as CXR in detecting lung consolidations but also consistent with clinical and laboratory data.

What is known:
• The diagnosis of pneumonia is mainly based on physical examination plus radiologic and laboratory evaluation when needed.
• Although lung ultrasound (LUS) has shown high sensitivity in detecting several pleuropulmonary diseases in adults, its role in the work-up of pneumonia in children is not yet widely recognized.
What is new:
• LUS is confirmed to be a reliable imaging technique for the diagnostic work-up of febrile children with respiratory distress, consistent not only with CXR results as previously reported by others but also with clinical and laboratory data.
• In the hands of trained clinicians, it may represent a valuable supplemental bedside tool for a rapid evaluation in such circumstances.

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Fig. 1
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Abbreviations

CAP:

community-acquired pneumonia

CRP:

C-reactive protein

CXR:

chest X-ray

ER:

emergency room

LUS:

lung ultrasound

PPE:

parapneumonic pleural effusion

WBC:

white blood cell

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Funding source

No external funding was secured for this study.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors declare that they have no competing interests.

Authors’ contributions

Mattia Guerra: Dr. Guerra planned and designed the study, performed the data collection, drafted the initial manuscript and approved the final manuscript as submitted.

Giovanni Crichiutti: Dr. Crichiutti planned and designed the study, carried out the ultrasound investigations, supervised the data collection, drafted the initial manuscript and approved the final manuscript as submitted.

Paolo Pecile: Dr. Pecile discussed the study design, carried out the ultrasound investigations, reviewed the manuscript and approved the final manuscript as submitted.

Carla Romanello: Dr. Romanello discussed the study design, carried out the ultrasound investigations, reviewed the manuscript and approved the final manuscript as submitted.

Eva Busolini: Dr. Busolini discussed the study design, participated in the initial data collection and approved the final manuscript as submitted.

Francesca Valent: Dr. Valent carried out the statistical analyses, reviewed the manuscript and approved the final manuscript as submitted.

Angelo Rosolen: Prof. Rosolen critically reviewed and revised the study and the manuscript.

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Author notes

    Authors and Affiliations

    1. Department of Clinical and Experimental Medical Sciences, Unit of Paediatrics, University Hospital of Udine, Ple. Santa Maria della Misericordia 15, Udine, 33100, Italy

      Mattia Guerra, Giovanni Crichiutti, Paolo Pecile, Carla Romanello, Eva Busolini & Angelo Rosolen

    2. Doctoral School in Sciences of Reproduction and Development, University of Trieste, Trieste, Italy

      Mattia Guerra

    3. Institute of Hygiene and Clinical Epidemiology, University Hospital and Epidemiological Service of Udine, Regione Friuli Venezia Giulia, Udine, Italy

      Francesca Valent

    4. Department of Paediatrics, University of Padova, Padova, Italy

      Angelo Rosolen

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    1. Mattia Guerra
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    Corresponding author

    Correspondence to Mattia Guerra.

    Additional information

    Mattia Guerra and Giovanni Crichiutti contributed equally to this work.

    Communicated by Jaan Toelen

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Ultrasound appearance of a hepatized lung consolidation and its uncomplicated pleural effusion, localized at the left costophrenic angle. LUS shows a marked liver-like appearance of the consolidated lung (WMV 1820 kb)

    Ultrasound appearance of normal lung sliding, which is the back-and-forth movement of the bright echogenic parietal and visceral pleura occurring during respiration (WMV 1909 kb)

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    Cite this article

    Guerra, M., Crichiutti, G., Pecile, P. et al. Ultrasound detection of pneumonia in febrile children with respiratory distress: a prospective study. Eur J Pediatr 175, 163–170 (2016). https://doi.org/10.1007/s00431-015-2611-8

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    • DOI: https://doi.org/10.1007/s00431-015-2611-8

    Keywords

    • Lung consolidation
    • Chest X-ray
    • Lung ultrasound
    • Paediatrician