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VOLUME 24 , ISSUE 6 ( June, 2020 ) > List of Articles

Pediatric Critical Care

Comparison of Efficacy of LUS and CXR in the Diagnosis of Children Presenting with Respiratory Distress to Emergency Department

Laila M Hegazy, Ahmed R Rezk, Hossam M Sakr, Asmaa S Ahmed

Citation Information : Hegazy LM, Rezk AR, Sakr HM, Ahmed AS. Comparison of Efficacy of LUS and CXR in the Diagnosis of Children Presenting with Respiratory Distress to Emergency Department. Indian J Crit Care Med 2020; 24 (6):459-464.

DOI: 10.5005/jp-journals-10071-23459

License: CC BY-NC 4.0

Published Online: 30-07-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Respiratory distress (RD) in children is a life-threatening condition. Delay in diagnosis has a deleterious effect on morbidity and mortality. The bedside lung ultrasound in emergency (BLUE) is a fast method that aims to accelerate the diagnosis with minimal radiological exposure. We targeted to evaluate the efficacy of BLUE protocol to speed and increase the precision of recognizing the cause of RD compared with chest X-ray (CXR) in the emergency department. Materials and methods: A cross-sectional study on 63 children with RD attended the emergency of a tertiary, university-affiliated, pediatric medical center between January 2017 and January 2018. Results: Most cases were males 52.4%. We designed to estimate the value of BLUE as a diagnostic tool for RD and comparing it with CXR. Pneumonia with or without pleural effusion was the main etiology of RD detected by BLUE in 47.7% of studied children, pulmonary edema in 22.2%, bronchiolitis and asthma in 17.4%, and pneumothorax in 12.7%. Lung ultrasound (LUS) was superior to CXR in the diagnosis of RD cause, and most cases, 47.7% were diagnosed with pneumonia with a sensitivity of 93.5% and specificity 96.9%. Conclusion: Bedside lung ultrasound in emergency is an effective tool for identifying the cause of RD which is more sensitive and specific compared with CXR.


  1. Warren J, Fromm REJ, Orr RA, Rotello LC, Horst HM. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 2004;32(1):256–262. DOI: 10.1097/01.CCM.0000104917. 39204.0A.
  2. Baldi G, Gargani L, Abramo A, D'Errico L, Caramella D, Picano E, et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med 2013;39(1):74–84. DOI: 10.1007/s00134-012-2694-x.
  3. Volpicelli G, El Barbary M, Blaivas M, Lichtenstein D, Mathis G, Kirkpatrick AW, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med [Internet] 2012. 38. DOI: 10.1007/s00134-012-2513-4.
  4. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134(1):117–125. DOI: 10.1378/chest.07-2800.
  5. Lichtenstein D, Mauriat P. Lung ultrasound in the critically ill neonate. Curr Pediatr Rev [Internet] 2012;8(3). DOI: 10.2174/157339612802139389.
  6. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care [Internet] 2014;4(1):1. DOI: 10.1186/2110-5820-4-1.
  7. Krishnan S, Moghekar A, Duggal A, Yella J, Narechania S, Ramachandran V, et al. Radiation exposure in the medical ICU: predictors and characteristics. Chest 2018;153(5):1160–1168. DOI: 10.1016/j.chest.2018.01.019.
  8. Reali F, Sferrazza Papa GF, Carlucci P, Fracasso P, Di Marco F, Mandelli M, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children? Respiration 2014;88(2):112–115. DOI: 10.1159/000362692.
  9. Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics 2015;135(4):714–722. DOI: 10.1542/peds.2014-2833.
  10. Lichtenstein DA. Ultrasound examination of the lungs in the intensive care unit. Pediatr Crit Care Med 2009;10(6):693–698. DOI: 10.1097/PCC.0b013e3181b7f637.
  11. Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 2011;37(9):1488–1493. DOI: 10.1007/s00134-011-2317-y.
  12. Dexheimer Neto FL, Andrade JMS, Raupp ACT, Townsend RS, Beltrami FG, Brisson H, et al. Diagnostic accuracy of the bedside lung ultrasound in emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients. J Bras Pneumol Publicacao of da Soc Bras Pneumol e Tisilogia 2015;41(1): 58–64. DOI: 10.1590/S1806-37132015000100008.
  13. Dexheimer Neto FL, Dalcin P, de TR, Teixeira C, Beltrami FG. Lung ultrasound in critically ill patients: a new diagnostic tool. J Bras Pneumol Publicacao of da Soc Bras Pneumol e Tisilogia 2012;38(2):246–256. DOI: 10.1590/s1806-37132012000200015.
  14. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015;147(6):1659–1670. DOI: 10.1378/chest.14-1313.
  15. Silva S, Biendel C, Ruiz J, Olivier M, Bataille B, Geeraerts T, et al. Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice. Chest 2013;144(3):859–865. DOI: 10.1378/chest.13-0167.
  16. Basile V, Di Mauro A, Scalini E, Comes P, Lofù I, Mostert M, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr [Internet] 2015;15(1):63. DOI: 10.1186/s12887-015-0380-1Available from: https://www.ncbi.nlm.nih.gov/pubmed/25993984.
  17. Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, et al. Lung ultrasound for diagnosing pneumothorax in the critically Ill neonate. J Pediatr 2016;175:74–78.e1. DOI: 10.1016/j.jpeds.2016.04.018.
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