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Evaluation of the diagnostic performance of physician lung ultrasound versus chest radiography for pneumonia diagnosis in a peri-urban South African cohort

  • Global Paediatric Radiology
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Lung ultrasound (US), which is radiation-free and cheaper than chest radiography (CXR), may be a useful modality for the diagnosis of pediatric pneumonia, but there are limited data from low- and middle-income countries.

Objectives

The aim of this study was to evaluate the diagnostic performance of non-radiologist, physician-performed lung US compared to CXR for pneumonia in children in a resource-constrained, African setting.

Materials and methods

Children under 5 years of age enrolled in a South African birth cohort study, the Drakenstein Child Health Study, who presented with clinically defined pneumonia and had a CXR performed also had a  lung US performed by a study doctor. Each modality was reported by two readers, using standardized methodology. Agreement between modalities, accuracy (sensitivity and specificity) of lung US and inter-rater agreement were assessed. Either consolidation or any abnormality (consolidation or interstitial picture) was considered as endpoints. In the 98 included cases (median age: 7.2 months; 53% male; 69% hospitalized), prevalence was 37% vs. 39% for consolidation and 52% vs. 76% for any abnormality on lung US and CXR, respectively. Agreement between modalities was poor for consolidation (observed agreement=61%, Kappa=0.18, 95% confidence interval [95% CI]: − 0.02 to 0.37) and for any abnormality (observed agreement=56%, Kappa=0.10, 95% CI: − 0.07 to 0.28). Using CXR as the reference standard, sensitivity of lung US was low for consolidation (47%, 95% CI: 31–64%) or any abnormality (5%, 95% CI: 43–67%), while specificity was moderate for consolidation (70%, 95% CI: 57–81%), but lower for any abnormality (58%, 95% CI: 37–78%). Overall inter-observer agreement of CXR was poor (Kappa=0.25, 95% CI: 0.11–0.37) and was significantly lower than the substantial agreement of lung US (Kappa=0.61, 95% CI: 0.50–0.75). Lung US demonstrated better agreement than CXR for all categories of findings, showing a significant difference for consolidation (Kappa=0.72, 95% CI: 0.58–0.86 vs. 0.32, 95% CI: 0.13–0.51).

Conclusion

Lung US identified consolidation with similar frequency to CXR, but there was poor agreement between modalities. The significantly higher inter-observer agreement of LUS compared to CXR supports the utilization of lung US by clinicians in a low-resource setting.

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Data availability

The data presented in this study is available on reasonable request from the corresponding author.

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Acknowledgements

We thank the participants of the Drakenstein Child Health Study and their families and the study and clinical staff. We are also grateful to and would like to thank Eckart von Delft for interpreting the chest radiographs.

Funding

The study was funded by the Bill and Melinda Gates Foundation (OPP 1017641) with additional grants from the Medical Research Council of South Africa, National Research Foundation and National Institute of Health and H3Africa (1U01AI110466–01A1).

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Shyam Sunder B. Venkatakrishna & Savvas Andronikou

  2. Department of Pediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa

    Jacob A. M. Stadler, David M. le Roux & Heather J. Zar

  3. Department of Pediatric Radiology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa

    Tracy Kilborn

  4. South African Medical Research Council (SAMRC), Unit On Child and Adolescent Health, University of Cape Town, Cape Town, South Africa

    Heather J. Zar

  5. Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Savvas Andronikou

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  1. Shyam Sunder B. Venkatakrishna
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Contributions

S.A. conceived the study and design. J.A.M.S. and S.A. performed data collection. S.S.B.V., J.A.M.S. and S.A. performed data analysis. S.S.B.V., J.A.M.S. and S.A. drafted the initial manuscript. T.K., D.M.L.R. and H.J.R. assisted with edits and review of the drafts. S.S.B.V. and S.A. performed reviews and revisions. All authors reviewed and approved the final manuscript.

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Correspondence to Savvas Andronikou.

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Venkatakrishna, S.S.B., Stadler, J.A.M., Kilborn, T. et al. Evaluation of the diagnostic performance of physician lung ultrasound versus chest radiography for pneumonia diagnosis in a peri-urban South African cohort. Pediatr Radiol 54, 413–424 (2024). https://doi.org/10.1007/s00247-023-05686-7

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  • DOI: https://doi.org/10.1007/s00247-023-05686-7

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