Point-of-care ultrasound for pneumonia diagnosis feasible in low-resource settings
Point-of-care ultrasound was shown to be a useful tool for nonphysician clinicians in South Sudan to determine whether children had pneumonia, according to a study published in The American Journal of Tropical Medicine and Hygiene.
Study researcher Adi Nadimpalii, MD, from Médecins Sans Frontières in Aweil, South Sudan, and colleagues noted that diagnosing and managing pneumonia in low-resource settings is challenging because of the lack of imaging devices and skilled clinicians. Previous research demonstrated that pediatric pneumonia cases in Asia and Africa are most likely to be caused by viral pathogens, and incorrect diagnosis could lead to inappropriate antibiotic use.
“There has been significant interest in using portable ultrasound technology in low- and middle-income countries, as it requires significantly less infrastructure and training than the current gold standard diagnostic imaging using chest X-rays,” the researchers wrote. “Point-of-care ultrasound (POCUS) is a widely used clinical imaging method for rapid diagnosis, can expedite treatment at the bedside and is relatively easy to learn.”
Nadimpalii and colleagues trained midlevel provider care clinical officers (COs) to use POCUS. Each CO then performed 60 lung studies using POCUS on hospitalized children aged younger than 5 years with suspected pneumonia.
Two blinded experts, plus one tie-breaking expert in cases where the experts disagreed, examined the COs’ quality and interpretation of the images.
During the study period, 360 studies were performed. The expert reviewers reported that nearly all images (99.1%) were acceptable, and 86% of the CO interpretations were appropriate.
According to Nadimpalii and colleagues, previous research suggests that examinations such as the ones included in this study take 7 minutes. However, examinations conducted by COs in this setting lasted 15 minutes.
“Determining how to conduct the examination quickly but with higher accuracy will be essential for making lung ultrasound easier to integrate into busy, under-resourced hospitals in low- and middle-income countries,” the researchers wrote. “Further research could also show how to interpret lung POCUS findings in contexts with high prevalence of other disease affecting pulmonary status, including malaria, tuberculosis and pediatric cardiac diseases, including congenital and rheumatic heart disease.” – by Katherine Bortz
Disclosures: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.