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Lung ultrasound beats chest X-ray for pediatric pneumonia: Mounting evidence

by Gus Iversen, Editor in Chief | March 25, 2015
Pneumonia is the number one cause of death in children worldwide, and increasing evidence may suggest lung ultrasound is a better first step in making a diagnosis than chest X-ray.

Ultrasound does not expose the patient to harmful ionizing radiation, costs less than chest X-ray, and may be just as accurate.

Research from the Icahn School of Medicine at Mount Sinai, entitled Feasibility and Safety of Substituting Lung Ultrasound for Chest X-Ray When Diagnosing Pneumonia in Children looked at 191 patients ranging from newborns to 21-year-olds, who arrived at their facility with symptoms of pneumonia requiring imaging for diagnosis.

The patients were divided into two groups. An investigational group of 103 received lung ultrasound right off the bat. If uncertainty remained, a chest X-ray could be done. The other 88 were the control arm, in which all patients had a chest X-ray followed by a lung ultrasound.

Only 63 of the 103 patients in the investigational group wound up needing follow-up X-ray imaging, resulting in a 40 percent reduction. In addition, the researchers reported no pneumonia cases were missed, and no adverse effects were reported from the sonograms.

"The reduction in chest X-ray utilization in the investigational arm resulted in a cost reduction of $9,620 overall. Median ED length of stay was decreased by 26 minutes for subjects in the investigational arm compared to the control arm by intent to treat analysis," wrote the researchers in their study abstract. They also report an average charge for chest X-ray at $370, versus $140 for point-of-care ultrasound.

Sonographer experience was a factor, too. Usage dipped 30 percent in sonographers who were inexperienced, (had performed fewer than 25 lung ultrasounds previously) versus a 60.6 percent drop among experienced sonographers.

Another group of researchers have found similar benefits with ultrasound for pediatric pneumonia, as well as a range of accuracy impacted by sonographer experience.

Published online in the journal Pediatrics on March 16th, the other researchers performed a meta-analysis of prior studies on the same topic, and homed in on eight studies concerning 765 children. They determined that pneumonia was accurately identified in pediatric patients 96 percent of the time. Again, the more experienced sonographers had the most success.

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