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European Journal of Pediatrics

, Volume 178, Issue 9, pp 1369–1377 | Cite as

Lung ultrasound in children with pneumonia: interoperator agreement on specific thoracic regions

  • Tiago Henrique de Souza
  • José Antonio Hersan NadalEmail author
  • Andressa Oliveira Peixoto
  • Ricardo Mendes Pereira
  • Marina Pavan Giatti
  • Ana Carolina Siqueira Soub
  • Marcelo Barciela Brandão
Original Article

Abstract

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.

Keywords

Ultrasound Ultrasonography Pneumonia Pediatrics Children 

Abbreviation

LUS

Lung ultrasonography

CXR

Chest X-ray

PPV

Positive predictive value

NPV

Negative predictive value

IQR

Interquartile range

CI

Confidence interval

Notes

Acknowledgments

Thank you to Carolina Grotta Ramos Telio for her review of the manuscript.

Authors’ contributions

T.H.dS. conceptualized and designed the study, collected data, drafted the initial manuscript, carried out the statisticalanalysis and reviewed and revised the manuscript. A.O.P. and J.A.H.N. designed the data collection instruments, collected data, and reviewed and revisedthe manuscript. M.P.G., A.C.S.S. and R.M.P. collected data. M.B.B. coordinated and supervised data collection, and critically reviewed the manuscript forimportant intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical standards

The study was approved by UNICAMP’s Research Ethics Committee (registration number 38170714.9.0000.5404), and a written informed consent was obtained from the participants’ legal guardians.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

431_2019_3428_MOESM1_ESM.tif (517 kb)
ESM 1 (TIF 517 kb)
431_2019_3428_Fig3_ESM.png (1.9 mb)

High Resolution Image (PNG 1926 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tiago Henrique de Souza
    • 1
  • José Antonio Hersan Nadal
    • 1
    Email author
  • Andressa Oliveira Peixoto
    • 2
  • Ricardo Mendes Pereira
    • 1
  • Marina Pavan Giatti
    • 1
  • Ana Carolina Siqueira Soub
    • 1
  • Marcelo Barciela Brandão
    • 1
  1. 1.Pediatric Intensive Care Unit, Department of PediatricsState University of Campinas (UNICAMP)CampinasBrazil
  2. 2.Discipline of Pediatric Pulmonology, Department of PediatricsState University of Campinas (UNICAMP)CampinasBrazil

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