Department of Respiratory, The Children's Hospital of Tianjin (Children's Hospital of Tianjin University), Tianjin, China.
Graduate School of Tianjin Medical University, Tianjin, China.
Pediatr Pulmonol. 2024 Dec;59(12):3130-3147. doi: 10.1002/ppul.27221. Epub 2024 Sep 6.
Chest radiography (CXR) is commonly used for diagnosing childhood pneumonia, but concerns about radiation exposure have raised interest in using radiation-free lung ultrasound (LUS) as an alternative imaging modality. Therefore, we designed this meta-analysis to compare the accuracy of LUS and CXR for diagnosing childhood pneumonia. We searched 8 databases and 1 clinical trial registry for studies published from inception to March 2023. Studies assessing lung ultrasound and chest radiography for diagnosing childhood pneumonia were included. Two reviewers independently screened literature, extracted data, and assessed the risk of bias using the QUADAS-2 tool for each study. Meta-analysis was conducted using a random-effects model, and pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristic (SROC) curve were assessed. Statistical analyses were performed using Meta-Disc 1.4, RevMan 5.4, and Stata 17.0 software. Heterogeneity was examined, and subgroup analysis was conducted to explore the accuracy of lung ultrasound in diagnosing childhood pneumonia. Out of the 4089 screened articles, 30 studies were included, encompassing a total of 4546 children. Of those, 3257 were diagnosed with pneumonia, 3190 through LUS, and 2925 via CXR. The meta-analysis showed that the sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of LUS were 0.940 (95% CI 0.930-0.949), 0.855 (95% CI 0.835-0.873), 7.561 (95% CI 4.956-11.536), 0.08 (95% CI 0.056-0.113), and 110.77 (95% CI 62.156-197.40), respectively. The combined area under the SROC curve was 0.9712, Q index = 0.9218. For CXR, the sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.893 (95% CI 0.881-0.905), 0.906 (95% CI 0.889-0.921), 18.742 (95% CI 7.551-46.520), 0.105 (95% CI 0.062-0.180), and 237.43 (95% CI 74.080-760.99), respectively. The combined area under the SROC curve was 0.9810, Q index = 0.9391. Subgroup analysis showed that the implementation location, interval between lung ultrasound and chest radiography, and operator experience had no impact on the accuracy of lung ultrasound in diagnosing childhood pneumonia. Existing evidence suggests that lung ultrasound has high accuracy for diagnosing childhood community-acquired pneumonia. Compared with chest radiography, lung ultrasound has higher sensitivity, similar specificity, and advantages such as radiation-free, lower cost, simplicity of operation, and ease of follow-up, making it an important imaging modality for diagnosing childhood pneumonia.
胸部 X 线摄影（CXR）常用于诊断儿童肺炎，但对辐射暴露的担忧引起了人们对使用无辐射肺部超声（LUS）作为替代成像方式的兴趣。因此，我们设计了这项荟萃分析，以比较 LUS 和 CXR 诊断儿童肺炎的准确性。我们从成立到 2023 年 3 月在 8 个数据库和 1 个临床试验注册处搜索了研究文献。纳入评估肺部超声和胸部 X 线摄影用于诊断儿童肺炎的研究。两位审阅者独立筛选文献、提取数据，并使用 QUADAS-2 工具评估每项研究的偏倚风险。使用随机效应模型进行荟萃分析，并评估汇总敏感性、特异性、阳性似然比、阴性似然比、诊断优势比和综合受试者工作特征（SROC）曲线。使用 Meta-Disc 1.4、RevMan 5.4 和 Stata 17.0 软件进行统计分析。检查了异质性，并进行了亚组分析，以探索 LUS 诊断儿童肺炎的准确性。在筛选出的 4089 篇文章中，有 30 篇研究被纳入，共纳入 4546 名儿童。其中，3257 名被诊断为肺炎，3190 名通过 LUS，2925 名通过 CXR。荟萃分析显示，LUS 的敏感性、特异性、阳性和阴性似然比以及诊断优势比分别为 0.940（95%CI 0.930-0.949）、0.855（95%CI 0.835-0.873）、7.561（95%CI 4.956-11.536）、0.08（95%CI 0.056-0.113）和 110.77（95%CI 62.156-197.40）。SROC 曲线下的综合面积为 0.9712，Q 指数=0.9218。对于 CXR，敏感性、特异性、阳性和阴性似然比以及诊断优势比分别为 0.893（95%CI 0.881-0.905）、0.906（95%CI 0.889-0.921）、18.742（95%CI 7.551-46.520）、0.105（95%CI 0.062-0.180）和 237.43（95%CI 74.080-760.99）。SROC 曲线下的综合面积为 0.9810，Q 指数=0.9391。亚组分析表明，LUS 的实施地点、LUS 与 CXR 之间的间隔以及操作人员的经验对 LUS 诊断儿童肺炎的准确性没有影响。现有证据表明，肺部超声对诊断儿童社区获得性肺炎具有较高的准确性。与 CXR 相比，肺部超声具有更高的敏感性、相似的特异性以及无辐射、成本更低、操作简单、易于随访等优势，是诊断儿童肺炎的重要成像方式。
