Point-of-Care Ultrasound is More Accurate than the Stethoscope in Diagnosing Pneumonia in Children
The new study from Mount Sinai was published in the online edition of Archives of Pediatrics & Adolescent Medicine.
Point-of-care ultrasound is more accurate than the traditional method of auscultation by stethoscope in diagnosing pneumonia in children and young adults, and can even detect small pneumonias that a chest x-ray may miss, a Mount Sinai researcher reports in an article titled, "Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults" in the online edition of Archives of Pediatrics & Adolescent Medicine published December 10, 2012.
These findings have important public health implications, especially in the developing world, as pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 1.2 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined.
"The World Health Organization has estimated as many as three-quarters of the world's population, especially in the developing world, does not have access to any diagnostic imaging, such as chest x-ray, to detect pneumonia," said senior author James Tsung, MD, MPH, Associate Professor of Emergency Medicine and Pediatrics at Mount Sinai School of Medicine. "Many children treated with antibiotics may only have a viral infection-- not pneumonia. Portable ultrasound machines can provide a more accurate diagnosis of pneumonia than a stethoscope."
Dr. Tsung of Mount Sinai, along with collaborators Vaishali Shah, MD of the Children's Hospital at Montefiore and Michael G. Tunik, MD of Bellevue Hospital Center/NYU School of Medicine, studied 200 patients from birth to 21 years of age who were presented to the emergency department with suspected community acquired pneumonia at Bellevue Hospital Center from 2008-2010. The criteria for inclusion were patients requiring a chest x-ray for evaluation. Sonologists, clinicians who perform and interpret ultrasonography, were given one hour of focused training prior to the start of the study on the use the ultrasonography to diagnose pneumonia.
Researchers found point-of-care ultrasound to be highly specific (97 percent) for diagnosing pneumonia, with sensitivity as high as 92 percent that can be achieved with training and experience. The accuracy for diagnosing pneumonia with the stethoscope was lower: specificity ranged from 77-83 percent, and sensitivity at 24 percent.
Further analysis of the data at Mount Sinai Medical Center revealed that ultrasound was able to identify pneumonia too small (less than 1 centimeter) for a chest x-ray to detect in 12 out of 48 patients with confirmed pneumonia.
Dr. Tsung and colleagues noted that diagnosing pneumonia with a stethoscope can be more difficult when a patient is wheezing or has co-existing diseases like asthma or bronchiolitis. This is not a problem for ultrasound.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli. The alveoli fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.
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The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Mount Sinai School of Medicine. Established in 1968, Mount Sinai School of Medicine is one of the leading medical schools in the United States. The Medical School is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation's oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation's top hospitals based on reputation, safety, and other patient-care factors. Of the top 20 hospitals in the United States, Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.
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