Comparison of chest radiograph and lung ultrasound in children with acute respiratory failure

Authors

Ryan L. DeSanti, Department of Pediatrics, Drexel College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA, USA. desantirl@gmail.com.
Kara G. Gill, Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Jonathan O. Swanson, Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Pierre D. Kory, Advocate Aurora Health
Jessica Schmidt, Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Eileen A. Cowan, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.Follow
Michael R. Lasarev, Department of Biostatistics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Awni M. Al-Subu, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.

Recommended Citation

DeSanti RL, Gill KG, Swanson JO, et al. Comparison of chest radiograph and lung ultrasound in children with acute respiratory failure. J Ultrasound. 2023;26(4):861-870. doi:10.1007/s40477-023-00827-y

Affiliations

St. Luke's Medical Center

Abstract

Purpose: Chest x-ray (CXR) is the standard imaging used to evaluate children in acute respiratory distress and failure. Our objective was to compare the lung-imaging techniques of CXR and lung ultrasound (LUS) in the evaluation of children with acute respiratory failure (ARF) to quantify agreement and to determine which technique identified a higher frequency of pulmonary abnormalities.

Methods: This was a secondary analysis of a prospective observational study evaluating the sensitivity and specificity of LUS in children with ARF from 12/2018 to 02/2020 completed at the University of Wisconsin-Madison (USA). Children > 37.0 weeks corrected gestational age and ≤ 18 years of age admitted to the PICU with ARF were evaluated with LUS. We compared CXR and LUS completed within 6 h of each other. Kappa statistics (k) adjusted for maximum attainable agreement (k/kmax) were used to quantify agreement between imaging techniques and descriptive statistics were used to describe the frequency of abnormalities.

Results: Eighty-eight children had LUS completed, 32 with concomitant imaging completed within 6 h are included. There was fair agreement between LUS and CXR derived diagnoses with 58% agreement (k/kmax = 0.36). Evaluation of imaging patterns included: normal, 57% agreement (k = 0.032); interstitial pattern, 47% agreement (k = 0.003); and consolidation, 65% agreement (k = 0.29). CXR identified more imaging abnormalities than LUS.

Conclusions: There is fair agreement between CXR and LUS-derived diagnoses in children with ARF. Given this, clinicians should consider the benefits and limitations of specific imaging modalities when evaluating children with ARF. Additional studies are necessary to further define the role of LUS in pediatric ARF given the small sample size of our study.

Document Type

Article

PubMed ID

37747593