Chest X-ray is the standard of care for diagnosing pneumonia in children, but a new Icahn School of Medicine at Mount Sinai study found that lung ultrasound may be a good alternative. The results have been published in the journal Chest.
Pneumonia is the leading cause of death in children around the world, according to the World Health Organization (WHO). Even though chest X-ray is the go-to exam, the WHO found that about three-quarters of the global population doesn't have access to it.
"I believe portable ultrasound will go a long way to reduce this health resource disparity," Dr. Jim Tsung, associate professor in emergency medicine and pediatrics at Icahn School of Medicine at Mount Sinai Hospital, told HCB News.
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With pneumonia, the lung fills up with pus and ultrasound can be used to look for that fluid. Ultrasound also is portable, costs less, doesn't emit radiation and can pick up small pneumonias that chest X-ray is unable to detect.
Tsung and his fellow researches decided to conduct a randomized controlled trial in the pediatric emergency department at The Mount Sinai Hospital to compare lung ultrasound and chest X-ray in 191 children from birth to 21 years old.
The patients were randomly placed in the group that received lung ultrasound (if the physician needed more information they performed chest X-ray) or in the control group that received chest X-ray followed by lung ultrasound.
The researchers found that there was a 38.8 percent reduction in chest X-rays in the group that received lung ultrasound first. There were also no missed pneumonia cases and no increase in any other adverse events.
Ultrasound is also much cheaper than other modalities. The reduction in chest X-rays resulted in an overall cost savings of $9,200 and the patients' lengths of stay in the emergency department decreased by 26 minutes.
One of the researchers believes that lung ultrasound is an ideal imaging modality in the era of precision medicine for children who are at a higher risk of radiation-induced cancers or have already received many radiographic or CT imaging exams.
In order for ultrasound to become the standard for diagnosing pneumonia in children, Tsung believes several things need to happen. First among them, ultrasound needs to be taught as being no different from the stethoscope in medical schools, allied health, nursing schools, and physician assistant and nurse practitioner schools.
Even though it's cheaper than other modalities, the cost of ultrasound technologies still needs to come down. With ultrasound being less costly than other forms of diagnostic imaging, it fits into the "value-based" health care model if it enables diagnoses that are quicker and safe.
