Lung ultrasonographic patterns of pneumonia in paediatric patients with respiratory symptoms admitted at Muhimbili National Hospital and Muhas academic medical centre

Abstract

Background: Pneumonia is a form of acute lower respiratory tract infection caused by viruses, bacteria and fungi and is the leading cause of death in children aged below 5 years worldwide and more occurs in developing countries. This study aimed at assessment of lung ultrasonographic findings of pneumonia among pediatric patients with respiratory symptoms pneumonia Methodology: This is descriptive cross-sectional, hospital based study enrolled 110 children with respiratory symptoms suspected of pneumonia undergone lung ultrasound. US was used for imaging and image evaluation was done by PI and Radiologist after reaching conscious. Analysis was done using Statistical package for social sciences (SPSS) version 23.Descriptive analysis was done using frequency and proportional for categorical variables and mean (standard deviation) for continuous variables. The main outcomes sonographic findings were computed as proportions of cases positive by LUS .The diagnostic ability was computed as outcome of the sensitivity, specificity and positive predictive value of standard clinical diagnoses compared to LUS as the gold standard. Chi-square P-value of <0.05 was considered statistically significant at 95% CI. Results: Of a hundred and ten children; majority 91 (82.7%) were below five years; and majority were male 79 (71.8%) Pneumonia was slightly non-significantly more in children aged below five years (65.9% vs. 63.2%, p=0.56). Most children presented with cough 106(96.4%), fever 104(94.5%) and difficulty in breathing 92(83.6 %). More than half of children had clinical diagnosis of pneumonia 58 (52.7%). Difficulty in breathing was significantly associated with pneumonia (70.7% vs. 38.9%, p value=0.010). However Fever (67.3%vs33.3; p=0.179), cough (67.0 % vs. 33%; p=0.118), lethargy (0% vs. 100%; p= 0.145) and vomiting everything (100% vs. 0%; p=0.387) were not significantly associated with pneumonia. Seventy two (65.5%) of children had LUS findings of pneumonia. Majority of patients (58.2%) had significant B lines, less than one third (29.1%) had consolidation and one fifth vi (20.9%) had pleural effusion. Lung ultrasonographic patterns associated with pneumonia were significant B-lines (p=0.000) and consolidation (p=0.00). Among 72 children with LUS findings of pneumonia only 52 were diagnosed clinically as having pneumonia sensitivity of 72.2%, Specificity 84.2%, Positive Predictive Value of 89.7%, and Negative predictive value of 61.5%, P-Value 0.00) Conclusion: Pneumonia diagnosis by LUS was significantly more than by clinical diagnosis, with Clinician performance in the diagnosis of pneumonia as compared to LUS had a sensitivity=72.2%,specificity 84.2%, Positive Predictive Value of 89.7%, and Negative predictive value of 61.5%, P-Value 0.00). Pneumonia by LUS was significantly associated with difficulty in breathing (70.7% vs. 38.9%, p-value=0.010), Significant B lines (p=0.000) and consolidation (p=0.000). Recommendations: LUS is superior to clinical diagnosis in detecting pneumonia and can be used or aid clinician in the diagnosis of pneumonia in paediatrics. Large similar study to be conducted with large sample size and include health facilities at different all levels of health care delivery to show the generalizable magnitude of performance of clinician against LUS in the diagnosis of pneumonia.