Özkaya Ahmet Kağan, Yilmaz Hayri Levent, Kendir Özlem Tolu, Gökay Sinem Sari, Eyüboğlu İlker
From the Department of Pediatric Emergency, Faculty of Medicine, Karadeniz Technical University, Ortahisar.
Pediatric Emergency Department, Trabzon Kanuni Training and Research Hospital, Numune Campus, Trabzon.
Pediatr Emerg Care. 2020 Mar;36(3):e135-e142. doi: 10.1097/PEC.0000000000001705.
The purposes of this study were to determine the benefit of the bronchiolitis ultrasound score (BUS) in predicting hospital admission in children with acute bronchiolitis and to characterize lung sonography findings.
This prospective observational study was performed in an academic pediatric emergency department. Children younger than 24 months presenting to the emergency department, diagnosed with acute bronchiolitis by 2 independent pediatricians were included in the study. Lung ultrasound was performed by a single sonographer, who was blinded to as much clinical information as possible. In addition, the treating physicians were blinded to the lung ultrasound findings. Logistic regression analysis models were used to identify admission predictors. Receiver operating characteristic analysis was used to evaluate the predictive value for effects of the BUS and the modified Bronchiolitis Severity Score on admission.
The median age of the 76 patients diagnosed with acute bronchiolitis was 6 months (interquartile range, 3.6-10 months). Forty-two (55.3%) of the 76 patients enrolled were admitted. Lung ultrasound was compatible with acute bronchiolitis in 74 patients (97%). A significant correlation was determined between modified Bronchiolitis Severity Score and BUS in children with acute bronchiolitis (r = 0.698, P < 0.001). The most effective parameter in determining admission on logistic regression analysis, independently of other variables, was BUS (P = 0.044; adjusted odds ratio, 1.859; 95% confidence interval, 1.016-3.404). Bronchiolitis ultrasound score values of 3 or greater exhibited 73.81% sensitivity and 73.53% specificity, whereas BUS values of 4 or greater exhibited 50% sensitivity and 91.18% specificity.
Point-of-care lung ultrasound can accurately detect pulmonary anomalies in children with acute bronchiolitis, has a close correlation with clinical findings, and is a useful tool in predicting hospital admission.
本研究旨在确定细支气管炎超声评分（BUS）在预测急性细支气管炎患儿住院方面的作用，并对肺部超声检查结果进行特征描述。
这项前瞻性观察性研究在一家学术性儿科急诊科进行。纳入研究的是年龄小于24个月、因急性细支气管炎就诊于急诊科且由两名独立儿科医生确诊的患儿。由一名超声检查医师进行肺部超声检查，该医师对尽可能多的临床信息不知情。此外，治疗医师对肺部超声检查结果也不知情。采用逻辑回归分析模型来确定住院预测因素。使用受试者工作特征分析来评估BUS和改良细支气管炎严重程度评分对住院影响的预测价值。
76例诊断为急性细支气管炎的患儿中位年龄为6个月（四分位间距，3.6 - 10个月）。76例纳入研究的患儿中有42例（55.3%）住院。74例（97%）患儿的肺部超声检查结果与急性细支气管炎相符。在急性细支气管炎患儿中，改良细支气管炎严重程度评分与BUS之间存在显著相关性（r = 0.698，P < 0.001）。在逻辑回归分析中，独立于其他变量，确定住院的最有效参数是BUS（P = 0.044；调整后的优势比，1.859；95%置信区间，1.016 - 3.404）。BUS值为3或更高时，敏感性为73.81%，特异性为73.53%；而BUS值为4或更高时，敏感性为50%，特异性为91.18%。
即时床旁肺部超声能够准确检测急性细支气管炎患儿的肺部异常情况，与临床检查结果密切相关，是预测住院的有用工具。
