Scheier Eric, Levick Nadine, Peled Julia, Balla Uri
Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel, affiliated to the Hebrew University, Israel.
Pediatric Emergency Medicine Specialist.
Pediatr Qual Saf. 2020 Jul 7;5(4):e326. doi: 10.1097/pq9.0000000000000326. eCollection 2020 Jul-Aug.
Community-acquired pneumonia (CAP) is a significant cause of pediatric morbidity and mortality worldwide. Emergency department point of care ultrasound (POCUS) is a first-line modality for diagnosis of CAP. The current coronavirus disease 2019 pandemic creates a unique opportunity to incorporate lung POCUS into the evaluation of a broader range of children. It has increased the utility of lung POCUS in both evaluation and follow-up of pediatric coronavirus cases. An increased use of lung POCUS creates an opportunity for earlier diagnosis while allowing the opportunity for overdiagnosis of small infiltrates and atelectasis. We collated a case series to demonstrate the benefit of lung POCUS in a very broad range of children.
We collected a case series of 5 patients between December 2018 and December 2019 who presented nonclassically and were diagnosed with CAP on POCUS by a pediatric emergency physician.
Routine lung POCUS in ill children will allow treating physicians to identify and follow a pulmonary infiltrate consistent with CAP quickly. We anticipate that early and more frequent use of POCUS and earlier diagnosis of CAP may improve outcomes by decreasing healthcare encounters within the same illness and by reducing the incidence of late sequelae of pneumonia such as empyema and effusions. However, we acknowledge that this may come at the expense of the overtreatment of viral infiltrates and atelectasis. Further study is required to improve the specificity of lung POCUS in the evaluation of CAP.
社区获得性肺炎（CAP）是全球儿童发病和死亡的重要原因。急诊科即时超声检查（POCUS）是诊断CAP的一线方法。当前的2019冠状病毒病大流行创造了一个独特的机会，可将肺部POCUS纳入对更广泛儿童的评估中。它增加了肺部POCUS在儿科冠状病毒病例评估和随访中的效用。肺部POCUS使用的增加为早期诊断创造了机会，同时也带来了对小浸润灶和肺不张过度诊断的可能性。我们整理了一个病例系列，以证明肺部POCUS在非常广泛的儿童中的益处。
我们收集了2018年12月至2019年12月期间5例非典型表现且由儿科急诊医生通过POCUS诊断为CAP的病例系列。
对患病儿童进行常规肺部POCUS检查将使治疗医生能够快速识别并跟踪与CAP一致的肺部浸润灶。我们预计，早期更频繁地使用POCUS以及对CAP进行早期诊断，可能通过减少同一种疾病期间的医疗接触次数以及降低肺炎后期后遗症（如脓胸和胸腔积液）的发生率来改善治疗结果。然而，我们承认这可能会以对病毒浸润灶和肺不张的过度治疗为代价。需要进一步研究以提高肺部POCUS在CAP评估中的特异性。
