Value of transthoracic ultrasonography in diagnosing community acquired pneumonia (CAP) in children

Aims: Respiratory infections (RTI) are the commonest cause of acute presentation in paediatric primary care demanding the greatest bulk of work-load and antimicrobial prescription. Overprescription of antibiotics results from lack of reliable, readily available diagnostic tools.

Aim: to assess diagnostic value of ultrasonography (US) in children with RTI and follow-up of untreated patients with residual symptoms.

Method: In a prospective two phase study children (0–14 years) presenting with RTI over 40 months in a general paediatric practice were included.

Phase one: patients with clinical criteria for CAP underwent US. Abnormal scans were verified by chest x-rays.

Phase two: patients clinically suspected of Pneumonia had chest x-rays followed by US. Scans were performed by the same examiner using a 5MHz linear transducer (Toshiba, Capasee). All patients were followed up until complete recovery.

Results: In phase one (36 months) there were 1353 children presenting with RTI. Clinical features of CAP (tachypnea, fever, focal signs) prevailed in 170 patients who were scanned and 36 had US evidence of consolidation. In 34 of them x-ray showed corresponding abnormalities. In phase two (5 months) there were 308 attendants because of RTI and 15 had chest x-rays because of suspected CAP. From 13 children with normal chest x-rays, 12 also had normal scans.

Conclusion: US detected CAP in our sample of children with a sensitivity of 1 and specificity of 0.98 and may be a useful screening tool to determine the need for further investigations and antimicrobial treatment in primary care.