Department of Emergency Medicine, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
JAMA Pediatr. 2013 Feb;167(2):119-25. doi: 10.1001/2013.jamapediatrics.107.
To determine the accuracy of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults by a group of clinicians.
Prospective observational cohort study.
Two urban emergency departments.
Patients from birth to age 21 years undergoing chest radiography for suspected community-acquired pneumonia.
After documenting clinical examination findings, clinicians with 1 hour of focused training used ultrasonography to diagnose pneumonia in children and young adults.
Test performance characteristics for the ability of ultrasonography to diagnose pneumonia were determined using chest radiography as a reference standard. Subgroup analysis was performed in patients having lung consolidation exceeding 1 cm with sonographic air bronchograms detected on ultrasonography; specificity and positive likelihood ratio (LR) were calculated to account for lung consolidation of 1 cm or less with sonographic air bronchograms undetectable by chest radiography.
Two hundred patients were studied (median age, 3 years; interquartile range, 1-8 years); 56.0% were male, and the prevalence of pneumonia by chest radiography was 18.0%. Ultrasonography had an overall sensitivity of 86% (95% CI, 71%-94%), specificity of 89% (95% CI, 83%-93%), positive LR of 7.8 (95% CI, 5.0-12.4), and negative LR of 0.2 (95% CI, 0.1-0.4) for diagnosing pneumonia by visualizing lung consolidation with sonographic air bronchograms. In subgroup analysis of 187 patients having lung consolidation exceeding 1 cm, ultrasonography had a sensitivity of 86% (95% CI, 71%-94%), specificity of 97% (95% CI, 93%-99%), positive LR of 28.2 (95% CI, 11.8-67.6) and negative LR of 0.1 (95% CI, 0.1-0.3) for diagnosing pneumonia.
Clinicians are able to diagnose pneumonia in children and young adults using point-of-care ultrasonography, with high specificity.
通过一组临床医生确定床边超声诊断儿童和青年社区获得性肺炎的准确性。
前瞻性观察队列研究。
两家城市急诊室。
因疑似社区获得性肺炎行胸部 X 线检查的出生至 21 岁患者。
在记录临床检查结果后，经过 1 小时重点培训的临床医生使用超声诊断儿童和青年肺炎。
使用胸部 X 线作为参考标准，确定超声诊断肺炎的能力的测试性能特征。对在超声上检测到超过 1 cm 的肺实变且超声空气支气管征的患者进行亚组分析；计算特异性和阳性似然比（LR）以说明胸部 X 线检查无法检测到 1 cm 或更小的肺实变和超声空气支气管征。
共研究了 200 例患者（中位年龄 3 岁；四分位距 1-8 岁）；56.0%为男性，胸部 X 线检查肺炎患病率为 18.0%。超声检查对有超声空气支气管征的肺实变的总体敏感性为 86%（95%CI，71%-94%），特异性为 89%（95%CI，83%-93%），阳性 LR 为 7.8（95%CI，5.0-12.4），阴性 LR 为 0.2（95%CI，0.1-0.4）。在 187 例肺实变超过 1 cm 的亚组分析中，超声检查对有超声空气支气管征的肺实变的敏感性为 86%（95%CI，71%-94%），特异性为 97%（95%CI，93%-99%），阳性 LR 为 28.2（95%CI，11.8-67.6），阴性 LR 为 0.1（95%CI，0.1-0.3）。
临床医生能够使用床边超声诊断儿童和青年社区获得性肺炎，特异性高。
