Background: Guidelines currently do not recommend the routine use of chest x-ray (CXR) in bronchiolitis. However,\nCXR is still performed in a high percentage of cases, mainly to diagnose or rule out pneumonia. The inappropriate use\nof CXR results in children exposure to ionizing radiations and increased medical costs. Lung Ultrasound (LUS) has\nbecome an emerging diagnostic tool for diagnosing pneumonia in the last decades. The purpose of this study was\nto assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with\nbronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.\nMethods: We enrolled children admitted to our hospital in 2016â??2017 with a diagnosis of bronchiolitis and\nundergone CXR because of clinical suspicion of concomitant pneumonia. LUS was performed in each child by a\npediatrician blinded to the patientâ??s clinical, laboratory and CXR findings. An exploratory analysis was done in the\nfirst 30 patients to evaluate the inter-observer agreement between a pediatrician and a radiologist who independently\nperformed LUS. The diagnosis of pneumonia was established by an expert clinician based on the recommendations of\nthe British Thoracic Society guidelines.\nResults: Eighty seven children with bronchiolitis were investigated. A final diagnosis of concomitant pneumonia was\nmade in 25 patients. Sensitivity and specificity of LUS for the diagnosis of pneumonia were 100% and 83.9%\nrespectively, with an area under-the-curve of 0.92, while CXR showed a sensitivity of 96% and specificity of 87.1%.\nWhen only consolidation > 1 cm was considered consistent with pneumonia, the specificity of LUS increased to\n98.4% and the sensitivity decreased to 80.0%, with an area under-the-curve of 0.89. Cohenâ??s kappa between\npediatrician and radiologist sonologists in the first 30 patients showed an almost perfect agreement in diagnosing\npneumonia by LUS (K 0.93).\nConclusions: This study shows the good accuracy of LUS in diagnosing pneumonia in children with clinical bronchiolitis.\nWhen including only consolidation size > 1 cm, specificity of LUS was higher than CXR, avoiding the need to perform\nCXR in these patients. Added benefit of LUS included high inter-observer agreement.\nTrial registration: Identifier: NCT03280732. Registered 12 September 2017 (retrospectively registered).
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