The role of “POINT-OF-CARE ULTRASONOGRAPHY” in the management of community-acquired pneumonia in outpatients

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.