The Feasibility Study Of Lung Ultrasound For The Diagnosis Of Community-acquired Pneumonia In Children

Objective:Discuss the feasibility study of Lung Ultrasound(LUS)for diagnosis of community-acquired pneumonia(CAP)in children.Materials and methods:Selected 110 cases under 14 years old who march to clinical manifestations of childhood CAP in our hospital between October 2015 to March 2017 as the research object.They undergone CT,X-ray and LUS.Reference standard CT for pneumonia diagnosis was used as reference.The children were divided into CAP group and control group.The clinical information,clinical symptoms and signs,CT,X-ray and LUS were recorded.The ultrasonographic features of childhood CAP were recorded,including the presence of line A and line B;whether the pleural line has changed or not;Whether the weak echo area or consolidation area;with or without bronchial sign;lesions rich in blood flow and with or without pleural effusion,if there is a weak echo area or consolidation area,measuring its left and right diameter,depth and upper and lower diameters,and finally made Ultrasound diagnosis.Twenty-seven children underwent pulmonary ultrasonography before discharge,and observed changes in the size of line A,line B,pleural line,weak echo zone or consolidation area.Analysis(1)CAP in children with the control group of lung clinical features and ultrasound indicators of the comparison,analysis of LUS diagnosis of CAP value.(2)Comparative analysis of LUS,chest X-ray diagnosis of childhood CAP clinical value,the main statistical indicators,including sensitivity,specificity,positive predictive value,negative predictive value,accuracy and ROC curve.(3)Analysis of changes in lung ultrasound in children with CAP before and after treatment.(4)Analysis of inflammatory indicators of childhood CAP in the diagnostic efficacy.Results:CT diagnosis of children with pneumonia for 70 cases of children with CAP group,CT diagnosis of pneumonia in children with the same period as the control group 40cases.1.Childhood CAP and control group were significantly different in gender,age,fever,cough and respiratory tone(The first threeχ~2 were 4.522,11.973,53.721,all P values were<0.05),There was significant difference in ESR and CRP between the two groups(t=5.118,2.840,P<0.05).There was no significant difference for the mycoplasma,influenza A virus,parainfluenza virus,PPD,WBC infection index between the two groups(P>0.05).2.There were significant differences in indexes such as line A,line B,pleural line abnormality,bronchial sign,abnormal blood flow,weak echo area or consolidation area(P<0.05).A line of the sensitivity(%)of the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were82.86%,95.00%,96.67%,76.00%,96.67%;.The sensitivity(%)of the B line in the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were 70.00%,95.00%,96.78%,64.47%,80.00%.Pleural line abnormal degree of the sensitivity(%)of the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were 44.29%,100.00%,100.00%,50.63%,100.00%;The sensitivity(%)of the air-filled bronchi in the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were 55.71%,100.00%,100.00%,56.34%,71.82%;Abnormal blood flow to the sensitivity(%)of the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were 62.86%,100.00%,100.00%,60.61%,100.00%;Abnormal blood flow to the sensitivity(%)of the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were 62.86%,100.00%,100.00%,60.61%,100.00%;Areas of consolidation/the weak echo regionthe sensitivity(%)of the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)were 67.14%,100.00%,100.00%,63.49%,100.00%.3.LUS predict childhood CAP of effectiveness and chest X ray film:CT diagnosis of pneumonia in 70 cases,LUS diagnosis positive about 55 cases of children,Negative with15 cases,Chest X-ray diagnosis of children with positive about 58 cases,Negative children12 cases.The sensitivity(%)of the LUS indicator in the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%)is respectively 78.57%,95%,0.878,96.49%,71.70%,0.880.The sensitivity(%)of the X-ray chest radiograph indicator in the diagnosis of childhood CAP,specific degree(%),positive predictive value(%),negative predictive value(%)and accuracy(%),AUC respectively 82.86%,100.00%,100.00%,76.47%,88.89%,0.914 AUC was compared between the two group,the results showed no significant difference in diagnostic efficacy(z=0.772,P=0.440).4.There was significant difference in A line disappeared,pleural line abnormalities and weak echo area maximum diameter before and after treatment children treatment of CAP children(P<0.05),while B line no statistical difference before and after therapy(P>0.05).Conclusion:As a convenient and no radiation examination method,Ultrasound has a high sensitivity and specificity in the diagnosis of childhood CAP,positive predictive value close to X-ray.It is conducive to clinical diagnosis and follow-up.