Point-of-care lung ultrasound is more reliable than chest X-ray for ruling out acute chest syndrome in sickle cell pediatric patients: A prospective study.

BACKGROUND: Acute chest syndrome (ACS) is a leading cause of morbidity and mortality in sickle cell patients, and it is often challenging to establish its diagnosis. PROCEDURE: This was a prospective observational study conducted in a pediatric emergency (PEM) department. We aimed to investigate the performance characteristics of point-of-care lung ultrasound (LUS) for diagnosing ACS in sickle cell children. LUS by trained PEM physicians was performed and interpreted as either positive or negative for consolidation. LUS results were compared to chest X-ray (CXR) and discharge diagnosis as reference standards. RESULTS: Four PEM physicians performed the LUS studies in 79 suspected ACS cases. The median age was 8 years (range 1-17 years). Fourteen cases (18%) received a diagnosis of ACS based on CXR and 21 (26.5%) had ACS discharge diagnosis. Comparing to CXR interpretation as the reference standard, LUS had a sensitivity of 100% (95% CI: 77%-100%), specificity of 68% (95% CI: 56%-79%), positive predictive value of 40% (95% CI: 24%-56%), and negative predictive value of 100% (95% CI: 92%-100%). Overall LUS accuracy was 73.42% (95% CI: 62%-83%). Using discharge diagnosis as the endpoint for both CXR and LUS, LUS had significantly higher sensitivity (100% vs. 62%, p = .0047) and lower specificity (76% vs.100%, p = .0002). LUS also had lower positive (60% vs.100%, p < .0001) and higher negative (100% vs.77%, p = .0025) predictive values. The overall accuracy was similar for both tests (82% vs. 88%, p = .2593). CONCLUSION: The high negative predictive value, with narrow CIs, makes LUS an excellent ruling-out tool for ACS.

Point-of-care lung ultrasound imaging in pediatric COVID-19.

BACKGROUND: There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19. OBJECTIVE: To describe lung US imaging findings and aeration score of 34 children with COVID-19. METHODS: This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case. RESULTS: Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p = 0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US. CONCLUSION: Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.

Point-Of-Care Ultrasound for Lung Assessment in Patients With Severe Scoliosis and Chest Deformities: An Emergency Department Case Series.

BACKGROUND: Diagnosing pneumonia and other lung conditions can be challenging in patients with severe intellectual or physical disabilities or severe chest deformities. Physical examination is sometimes difficult to perform and the frequently requested chest x-ray (CXR) study is often of little value in the diagnostic approach to this population. Point-of-care lung ultrasound (US) is an emerging diagnostic tool with particularly high level of accuracy in detecting pneumonia, pleural effusion, and pneumothorax. CASE REPORT: This case series describes four cases demonstrating the usefulness of point-of-care US in a pediatric emergency department for lung assessment in patients for differentiation and diagnosis of acute causes of acute respiratory symptoms, in whom clinical features or CXR failed to confirm or exclude pulmonary complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with chest deformities, pulmonary complications can be disproportionately frequent. Lung US should be recognized as an important adjunctive tool in this subset of patients to detect pneumonia, pleural effusions, and pneumothorax. When used proactively, it can reduce unnecessary radiation exposure, provide more certainty in determining the diagnosis, and, most importantly, inform correct and timely management.

The diagnosis of concussion in a pediatric emergency department.

OBJECTIVES: To compare the proportion of children diagnosed with a concussion by pediatric emergency physicians vs the proportion who met criteria for this injury as recommended by Zurich Fourth International Conference on Concussion consensus statement and to determine clinical variables associated with a physician diagnosis of a concussion. STUDY DESIGN: This was a prospective, cross-sectional study conducted at a tertiary care pediatric emergency department. We enrolled children ages 5 through 17 who presented with a head injury and collected data on demographics, mechanism of injury, head injury-related symptoms/signs, physician diagnosis, and discharge advice. RESULTS: We identified 495 children whose mean age was 10.1 years (SD 3.4 years); 308 (62.2%) were male. Emergency physicians diagnosed concussion in 200 (40.4%; 95% CI 36.1, 44.7) children, and 443 (89.5%; 95% CI 86.8, 92.2) met criteria for concussion in accordance with the Zurich consensus statement (P<.0001). Age≥10 years (OR 1.8), presentation≥1 day after injury (OR 2.4), injury from collision sports (OR 5.6), and symptoms of headache (OR 2.2) or amnesia (OR 3.4) were the variables significantly associated with an emergency physician's diagnosis of concussion. CONCLUSIONS: Pediatric emergency physicians diagnosed concussion less often relative to international consensus-based guidelines and used a limited number of variables to make this diagnosis compared with current recommendations. Thus, pediatric emergency physicians may be missing cases of concussion and the corresponding opportunity to provide critical advice for cognitive and physical management.