Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress.
Am J Emerg Med
; 68: 112-118, 2023 06.
Article
en En
| MEDLINE
| ID: mdl-36966586
ABSTRACT
PURPOSE:
Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early recognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care.METHODS:
This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ultrasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h.RESULTS:
A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneumonia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC) 0.81 (95% confidence interval [CI] 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity 71.4%; specificity 79.4%; odds ratio (OR) 9.6 [95% CI 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI3.21-23.86).CONCLUSION:
An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Síndrome de Dificultad Respiratoria
/
Insuficiencia Respiratoria
/
Ventilación no Invasiva
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adolescent
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Child
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Child, preschool
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Humans
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Infant
/
Newborn
País como asunto:
America do sul
/
Brasil
Idioma:
En
Año:
2023
Tipo del documento:
Article