Maggio 2015 - Volume XXXIV - numero 5
Ricerca
1Pediatra di famiglia, ASL BR/1, Brindisi
2Dipartimento di Pediatria, Università Vita-Salute San Raffaele, Milano
Indirizzo per corrispondenza: antoniocaiulo@inwind.it
Key words: Community-acquired pneumonia, Lung ultrasound, Pneumonia, Point-of-care ultrasonography
Background - The diagnosis of community-acquired pneumonia (CAP) is based mainly
on medical history and physical examination. However, in severe cases a further evaluation
including chest X-ray (CXR) may be necessary. Actually, lung ultrasound (LUS) is not
included in the diagnostic work-up of pneumonia.
Objective - The aim of this study was to determine the role of point-of-care ultrasonography
in the management of CAP in outpatients. A secondary aim was to promote knowledge
of LUS among paediatricians.
Methods - 474 patients aged 1 to 14 with clinical symptoms of pneumonia were enrolled
in this study. Patients were divided into two groups. Children in group 1 (n=226)
were evaluated both with physical examination and with LUS performed by an expert
paediatric sonographer. LUS follow-up was stopped when the sonographic appearance
of the lung was normal. Children in group 2 (n=248) underwent only physical examination.
LUS was also performed in 78 children without clinical signs of CAP (control
group). The diagnosis of pneumonia was made on the basis of clinical presentation and
physical examination and/or LUS.
Results - Group 1: 34 out of the 226 patients (15%) were diagnosed with pneumonia. In
this group, LUS was diagnostic of pneumonia in 34/34 patients. 9/34 patients had normal
physical examination. During the follow-up, in all cases, clinical improvement was
associated with the disappearance of LUS findings. Group 2: 27 out of the 248 patients
(10.9%) were diagnosed with pneumonia. Of these 27 patients, 3 required hospitalization.
Control group: 78/78 children had normal LUS and normal physical examination.
Conclusions - Point-of-care ultrasonography can be used in paediatric ambulatory settings
to identify pleural parenchymal abnormalities in children with suspected community-
acquired pneumonia. Further studies are required to better define the role of lung ultrasound
in paediatric primary care.
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