Rolul ultrasonografiei pulmonare în diagnosticul pneumoniei comunitare la copii

Abstract

Community-acquired pneumonia in children (CAP) continues to be a significant cause of morbidity and mortality worldwide, accounting for 13% of infectious diseases in children under 2 years of age and the cause of over 800,000 infant deaths annually. Despite current guidelines, chest radiography (CXR) is still mainly used for imaging diagnosis of mild and/or uncomplicated cases of CAP in children. Aim: The aim of the study is to evaluate the contribution and reliability of pediatric lung ultrasound (PLUS) as an alternative test in the diagnosis of CAP in children. Methods: This retrospective study included 280 children diagnosed with CAP between June 2022 and February 2024, aged between 1 month and 13 years, conducted at the Municipal Children's Clinical Hospital No. 1 Results: CAP in children was confirmed through clinical methods, as well as CXR and PLUS investigations in 280 children. LUS showed pathological changes in 226 patients (80.71%), while CXR was abnormal in 223 (79.64%) cases. In radiologically diagnosed pneumonia, PLUS detected CAP in 205 out of 223 cases (91.92%); when CXR was normal, PLUS was abnormal in 21 out of 57 cases (36.84%). PLUS showed a sensitivity of 91.93% (95% CI: 87.54-95.15), specificity of 63.16% (95% CI: 49.34-75.56), compared to a sensitivity of 79.5% (95% CI: 72.43-84.06) and specificity of 63.15% (95% CI: 49.32-75.49) for CXR. The positive predictive value was 90.71% (95% CI: 87.40-93.22) and negative predictive value was 66,67% (95% CI: 55.18-76.47).The accuracy was 86.07% (95% CI: 81.45-89.90) for diagnosing CAP by PLUS in children. Conclusion: Pediatric lung ultrasound can be considered a valid alternative first-line diagnostic tool for CAP in children.