Xin Hua, Li Jie, Hu Hai-Yang
Ultrasound Q. 2018 Mar;34(1):3-10. doi: 10.1097/RUQ.0000000000000330.
Childhood mortality due to pneumonia is high. Chest radiography is the primary imaging modality used for the evaluation of pneumonia in children. Lung ultrasonography (LUS) is a newer, alternative diagnostic method that has been gaining popularity in recent years. We conducted a meta-analysis to summarize the diagnostic usefulness of LUS for childhood pneumonia.
All studies included in this meta-analysis were retrieved from PubMed, Elsevier's Science Direct, and Springer, and by manual searches including the use of reference lists, through March 31, 2017. Two researchers independently screened the literature, extracted the data, and evaluated risks of bias in accordance with the inclusion and exclusion criteria. For the meta-analysis, we calculated the pooled sensitivity and specificity, pooled positive likelihood ratio, negative likelihood ratio, and the diagnostic odds ratio. Summary receiver operating characteristic curve was used to assess the overall performance of LUS.
Our search identified 1038 articles, and we selected 51 of these for detailed review. Eight studies containing 1013 patients met all the inclusion criteria and were included in the final meta-analysis. The pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 93.0% (95% confidence interval, 88.0%-96.0%) and 96.0% (95% confidence interval, 92.0%-98.0%), respectively. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 25.8 (11.0, 60.4), 0.07 (0.05, 0.12), and 344 (104, 1140), respectively. In addition, the summary receiver operating characteristic area under the curve was calculated to be 0.98 (0.97, 0.99). A Fagan plot analysis demonstrated that when pretest probabilities were 25%, 50%, and 75%, the positive posttest probabilities were 90%, 96%, and 99%, respectively, and the negative posttest probabilities were 2%, 7%, and 18%, respectively. Four clinical signs were most frequently observed using LUS in the screening of children with pneumonia: pulmonary consolidation, positive air bronchogram, abnormal pleural line, and pleural effusion.
Current evidence supports LUS as a useful imaging alternative for the diagnosis of childhood pneumonia. That it is easily carried out, readily available, relatively inexpensive, and free from the hazards of radiation make it an attractive alternative to chest radiography and physical examination for the diagnosis and the follow-up of pneumonia in children.
肺炎导致的儿童死亡率很高。胸部X线摄影是评估儿童肺炎的主要影像学检查方法。肺部超声检查（LUS）是一种较新的替代诊断方法，近年来越来越受欢迎。我们进行了一项荟萃分析，以总结LUS对儿童肺炎的诊断价值。
本荟萃分析纳入的所有研究均从PubMed、爱思唯尔科学Direct和施普林格数据库中检索，并通过手动检索包括参考文献列表，检索截止至2017年3月31日。两名研究人员独立筛选文献、提取数据，并根据纳入和排除标准评估偏倚风险。对于荟萃分析，我们计算了合并敏感度和特异度、合并阳性似然比、阴性似然比和诊断比值比。采用汇总受试者工作特征曲线评估LUS的总体性能。
我们的检索共识别出1038篇文章，其中51篇被选作详细综述。八项研究共纳入1013例患者，均符合所有纳入标准，被纳入最终的荟萃分析。使用LUS诊断肺炎的合并敏感度和特异度分别为93.0%（95%置信区间，88.0%-96.0%）和96.0%（95%置信区间，92.0%-98.0%）。合并阳性似然比、阴性似然比和诊断比值比分别为25.8（11.0，60.4）、0.07（0.05，0.12）和344（104，1140）。此外，汇总受试者工作特征曲线下面积计算为0.98（0.97，0.99）。Fagan图分析表明，当验前概率为25%、50%和75%时，验后阳性概率分别为90%、96%和99%，验后阴性概率分别为2%、7%和18%。在筛查肺炎儿童时，使用LUS最常观察到的四个临床体征为：肺实变、空气支气管征阳性、胸膜线异常和胸腔积液。
目前的证据支持LUS作为诊断儿童肺炎的一种有用的影像学替代方法。它易于操作、随时可用、相对便宜且无辐射危害，使其成为儿童肺炎诊断和随访中胸部X线摄影和体格检查的有吸引力的替代方法。
