Pediatric Intensive Care Unit, Department of Pediatrics, State University of Campinas (UNICAMP), 1000, Hermantino Coelho St., Campinas, SP, 13087-500, Brazil.
Discipline of Pediatric Pulmonology, Department of Pediatrics, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
Eur J Pediatr. 2019 Sep;178(9):1369-1377. doi: 10.1007/s00431-019-03428-2. Epub 2019 Jul 16.
The objective of this study was to evaluate the interoperator agreement of lung ultrasonography (LUS) on specific thoracic regions in children diagnosed with pneumonia and to compare the findings of the LUS with the chest X-ray. Participants admitted to the ward or PICU underwent LUS examinations performed by an expert and a novice operator. A total of 261 thoracic regions in 23 patients were evaluated. Median age and weight of participants were 30 months and 11.6 kg, respectively. A substantial overall agreement between operators was found for normal lung tissue (κ = 0.615, 95% confidence interval (95% CI) = 0.516-0.715) and for consolidations (κ = 0.635, 95% CI = 0.532-0.738). For B-lines, a moderate agreement was observed (κ = 0.573, 95% CI = 0.475-0.671). An almost perfect agreement was found for pleural effusion (κ = 0.868, 95% CI = 0.754-0.982). The diagnosis of consolidations by LUS showed a high sensitivity (93% for both operators) but a low specificity (14% for expert and 25% for novice operator). While intubated patients presented significantly more consolidations, nonintubated patients presented more normal ultrasound patterns.Conclusion: Even when performed by operators with very distinct degrees of experience, LUS had a good interoperator reliability for detecting sonographic patterns on specific thoracic regions. What is Known: • Lung ultrasound is feasible, safe, and highly accurate for the diagnosis of pneumonia in children; however, it does not allow global visualization of the thorax in a single moment as in chest X-rays, and, similar to the stethoscope, partial thorax assessments must be performed sequentially. What is New: • This is the first study evaluating the agreement of LUS on specific thoracic regions between operators with distinct degrees of experience performing the sonograms. • There is a good agreement between an expert operator and a novice operator who underwent a brief theoretical-practical training program on LUS.
本研究的目的是评估肺部超声（LUS）在诊断肺炎的儿童特定胸部区域的操作者间一致性，并将 LUS 的结果与胸部 X 射线进行比较。入住病房或 PICU 的参与者接受了专家和新手操作者进行的 LUS 检查。共评估了 23 名患者的 261 个胸部区域。参与者的中位年龄和体重分别为 30 个月和 11.6 公斤。两名操作者对正常肺组织（κ=0.615，95%置信区间（95%CI）=0.516-0.715）和实变（κ=0.635，95%CI=0.532-0.738）的总体一致性较高。对于 B 线，观察到中度一致性（κ=0.573，95%CI=0.475-0.671）。胸腔积液的一致性几乎完美（κ=0.868，95%CI=0.754-0.982）。LUS 对实变的诊断具有较高的敏感性（两名操作者均为 93%），但特异性较低（专家为 14%，新手为 25%）。与插管患者相比，未插管患者的超声正常模式更多。结论：即使由经验水平截然不同的操作者进行操作，LUS 对检测特定胸部区域的超声模式也具有良好的操作者间可靠性。已知内容：• 肺部超声对于儿童肺炎的诊断是可行、安全且高度准确的；然而，它不能像胸部 X 射线那样在单个瞬间对整个胸部进行全局可视化，并且与听诊器一样，必须依次对部分胸部进行评估。新内容：• 这是第一项评估经验水平不同的操作者在特定胸部区域进行 LUS 时的一致性的研究。• 经验丰富的操作者和经过简短的 LUS 理论实践培训的新手操作者之间存在良好的一致性。
