Ultrasound may replace X-ray in pneumonia diagnosis
Lung ultrasound (LUS) appears to be a safe, effective substitute for chest X-ray (CXR) in the diagnosis of pneumonia in children, according to a recent study.
To determine the feasibility and safety of substituting LUS for CXR when evaluating children with suspected pneumonia, researchers conducted a randomized controlled trial involving 191 patients aged 0 to 21 years. Patients in the CXR arm received sequential LUS, whereas those in the LUS arm only received subsequent CXR when the physician needed additional verification.
Primary outcome was the rate of CXR reduction. Secondary outcomes were missed pneumonia, subsequent unscheduled healthcare visits, and adverse events between the two arms.
The LUS arm showed a 38.8 percent reduction (95 percent CI, 0.30 to 0.489) in CXR compared to no reduction (0.0 to 0.036) in the CXR arm. CXR use by novice and veteran clinician-sonologists decreased by 30 and 60.6 percent, respectively.
There were no instances of missed pneumonia among all study participants. Adverse events or subsequent unscheduled healthcare visits did not differ between arms.
Reduced use of chest X-rays in the LUS arm generated an overall cost savings of $9,200 and cut the length of hospital stay by 26 mins.
Unlike an X-ray, ultrasound is portable, economical, and safer for children because it does not expose them to radiation.
Pneumonia is the leading cause of death in children worldwide. In Singapore, it ranks second among the top killer disease among children and adults, accounting for 18.5 percent of deaths in 2013, according to the Ministry of Health.
CXR is the gold standard for diagnosing pneumonia, but the World Health Organisation estimates three-quarters of the world’s population does not have access to radiography.
The findings could have a profound impact in the developing world where access to radiography is limited, researchers noted. Lung ultrasound could also be an ideal imaging option in children who are at higher risk for radiation-induced cancers or have received multiple radiographic or CT imaging studies.
Further research is needed to investigate the impact of lung ultrasound on antibiotic use and stewardship.