Department of Pediatrics, Drexel College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA, USA.
Department of Critical Care Medicine, St Christopher's Hospital for Children, 160 East Erie Avenue, Third Floor Suite, Office A3-20k, Philadelphia, PA, 19143, USA.
J Ultrasound. 2023 Dec;26(4):861-870. doi: 10.1007/s40477-023-00827-y. Epub 2023 Sep 25.
Chest x-ray (CXR) is the standard imaging used to evaluate children in acute respiratory distress and failure. Our objective was to compare the lung-imaging techniques of CXR and lung ultrasound (LUS) in the evaluation of children with acute respiratory failure (ARF) to quantify agreement and to determine which technique identified a higher frequency of pulmonary abnormalities.
This was a secondary analysis of a prospective observational study evaluating the sensitivity and specificity of LUS in children with ARF from 12/2018 to 02/2020 completed at the University of Wisconsin-Madison (USA). Children > 37.0 weeks corrected gestational age and ≤ 18 years of age admitted to the PICU with ARF were evaluated with LUS. We compared CXR and LUS completed within 6 h of each other. Kappa statistics (k) adjusted for maximum attainable agreement (k/k) were used to quantify agreement between imaging techniques and descriptive statistics were used to describe the frequency of abnormalities.
Eighty-eight children had LUS completed, 32 with concomitant imaging completed within 6 h are included. There was fair agreement between LUS and CXR derived diagnoses with 58% agreement (k/k = 0.36). Evaluation of imaging patterns included: normal, 57% agreement (k = 0.032); interstitial pattern, 47% agreement (k = 0.003); and consolidation, 65% agreement (k = 0.29). CXR identified more imaging abnormalities than LUS.
There is fair agreement between CXR and LUS-derived diagnoses in children with ARF. Given this, clinicians should consider the benefits and limitations of specific imaging modalities when evaluating children with ARF. Additional studies are necessary to further define the role of LUS in pediatric ARF given the small sample size of our study.
胸部 X 光（CXR）是用于评估急性呼吸窘迫和衰竭儿童的标准成像方法。我们的目的是比较 CXR 和肺部超声（LUS）在评估急性呼吸衰竭（ARF）儿童中的肺部成像技术，以量化一致性，并确定哪种技术能发现更高频率的肺部异常。
这是一项对 2018 年 12 月至 2020 年 2 月在美国威斯康星大学麦迪逊分校进行的评估 LUS 在 ARF 儿童中的敏感性和特异性的前瞻性观察研究的二次分析。患有 ARF 并入住 PICU 的儿童 > 37.0 周校正胎龄和 ≤ 18 岁，接受 LUS 评估。我们比较了在彼此 6 小时内完成的 CXR 和 LUS。使用最大可达到一致性调整的 Kappa 统计量（k/k）来量化成像技术之间的一致性，并使用描述性统计来描述异常的频率。
88 名儿童完成了 LUS，其中 32 名儿童在 6 小时内完成了相应的成像。LUS 和 CXR 得出的诊断结果之间存在适度的一致性，有 58%的一致性（k/k=0.36）。对成像模式的评估包括：正常，57%的一致性（k=0.032）；间质性模式，47%的一致性（k=0.003）；和实变，65%的一致性（k=0.29）。CXR 比 LUS 识别出更多的影像学异常。
在 ARF 儿童中，CXR 和 LUS 得出的诊断结果之间存在适度的一致性。鉴于此，临床医生在评估 ARF 儿童时应考虑特定成像方式的优势和局限性。由于我们的研究样本量较小，需要进一步研究来进一步确定 LUS 在儿科 ARF 中的作用。
