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Lung ultrasound in diagnosing pneumonia in childhood: a systematic review and meta-analysis

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Abstract

Purpose

Pneumonia is the third leading cause of death in children under 5 years of age worldwide. In pediatrics, both the accuracy and safety of diagnostic tools are important. Lung ultrasound (LUS) could be a safe diagnostic tool for this reason. We searched in the literature for diagnostic studies about LUS to predict pneumonia in pediatric patients using systematic review and meta-analysis.

Methods

The Medline, CINAHL, Cochrane Library, Embase, SPORTDiscus, ScienceDirect, and Web of Science databases from inception to September 2017 were searched. All studies that evaluated the diagnostic accuracy of LUS in determining the presence of pneumonia in patients under 18 years of age were included.

Results

1042 articles were found by systematic search. 76 articles were assessed for eligibility. Seventeen studies were included in the systematic review. We included 2612 pooled cases. The age of the pooled sample population ranged from 0 to about 21 years old. Summary sensitivity, specificity, and AUC were 0.94 (IQR: 0.89–0.97), 0.93 (IQR: 0.86–0.98), and 0.98 (IQR: 0.94–0.99), respectively. No agreement on reference standard was detected: nine studies used chest X-rays, while four studies considered the clinical diagnosis. Only one study used computed tomography.

Conclusions

LUS seems to be a promise tool for diagnosing pneumonia in children. However, the high heterogeneity found across the individual studies, and the absence of a reliable reference standard, make the finding questionable. More methodologically rigorous studies are needed.

Sommario

Obiettivo

La polmonite è la terza causa di morte nel mondo al di sotto dei 5 anni. In campo pediatrico, sia l’accuratezza che la sicurezza degli strumenti diagnostici sono importanti. In questo senso l’ecografia polmonare (LUS) potrebbe essere uno strumento diagnostico sicuro. Abbiamo analizzato la letteratura sull’accuratezza della LUS nel diagnosticare la polmonite nei pazienti pediatrici attraverso una revisione sistematica e una meta-analisi.

Metodi

Sono stati consultati i database Medline, CINAHL, Cochrane Library, Embase, SPORTDiscus, ScienceDirect e Web of Science dal loro avvio alla fine di settembre 2017. Sono stati inclusi tutti gli studi che hanno valutato l’accuratezza diagnostica della LUS nel determinare la presenza di polmonite nei pazienti di età inferiore ai 18 anni. 1.042 articoli sono stati trovati dalla ricerca sistematica. 76 articoli sono stati valutati per l’ammissibilità. 17 studi sono stati inclusi nella revisione sistematica.

Risultati

Abbiamo incluso 2.612 casi raggruppati. L’età della popolazione campione raggruppata varia da 0 a circa 21 anni. Sensibilità, specificità e AUC sono rispettivamente 0,94 (IQR: 0,89–0,97); 0,93 (IQR: 0,86–0,98) e 0,98 (IQR: 0,94–0,99). Non è stato rilevato accordo sullo standard di riferimento: 9 studi hanno usato la radiografia del torace; 4 studi hanno considerato la diagnosi clinica. Solo uno studio ha utilizzato la tomografia computerizzata.

Conclusioni

La LUS sembra essere uno strumento promettente per diagnosticare la polmonite nei bambini. Tuttavia l’elevata eterogeneità riscontrata nei singoli studi e l’assenza di uno standard di riferimento affidabile rendono discutibile il risultato. Sono necessari studi metodologicamente più rigorosi.

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Correspondence to Daniele Orso.

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40477_2018_306_MOESM1_ESM.jpg

Figure 8 Comparison of the sensitivity for individual studies for every sampling method. On the left column are the individual studies. On the right column is the sensitivity (95%CI). Prospective = prospective enrolment; Retrospective = retrospective enrolment; TP = true positives; FP = false positives; TN = true negatives; FN = false negatives. The dashed area represents the 95% confidence interval (JPEG 224 kb)

40477_2018_306_MOESM2_ESM.jpg

Figure 9 Comparison of the specificity for individual studies for every sampling method. On the left column are the individual studies. On the right column is the specificity (95%CI). Prospective prospective enrolment; Retrospective retrospective enrolment; TP true positives; FP false positives; TN true negatives; FN false negatives. The dashed area represents the 95% confidence interval (JPEG 220 kb)

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Orso, D., Ban, A. & Guglielmo, N. Lung ultrasound in diagnosing pneumonia in childhood: a systematic review and meta-analysis. J Ultrasound 21, 183–195 (2018). https://doi.org/10.1007/s40477-018-0306-5

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