الفهرس 
Diagnostic Accuracy of Lung Ultrasound Versus Chest X-Ray in Infants with Acute Lower Respiratory Tract Infections
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Abstract
Background: Acute lower respiratory tract infections (ALRTIs) remain an issue of great concern in the modern world. As it represent the fifth leading cause of death overall and the leading infectious cause of death in children younger than 5 years. Our research is a step on the way towards novel application of point-of-care diagnostic lung ultrasound (LUS) in acute respiratory conditions that can be complementary to chest x-rays (CXR) or even superior to it. It is a simple, rapid, non-invasive, non radiating, dynamic assessment tool.
The objective: The aim of this study is to assess diagnostic accuracy of lung ultrasound versus chest x-ray in infants with ALRTIs.
Subjects and methods: This is a prospective study conducted on sixty cases aged from 2 months up to 2 years with acute lower respiratory tract diseases who need chest x-ray as a work up and admission in Abo El-Reesh children hospital during the period from April 2019 to April 2021. All patients performed the LUS using a six-zone scanning protocol. The treating physician remained blinded to ultrasound findings; final diagnoses were extracted from the medical record. Positive LUS was defined as the presence of ≥1 of the following findings: ≥3 B-lines per intercostal space, consolidation and/or pleural abnormalities.
Results: LUS was positive in 78.3% (47/60) of patients, while CXR was positive in 95% (57/60). The LUS had good discriminative ability for detection of non complicated and complicated pneumonia with sensitivity (93.5%, 100%), specificity (37.9%, 26.5%) and AUC (0.732, 0.617), respectively. The LUS had no significant discriminative ability for detection of bronchiolitis and asthma with sensitivity (36.4%, 42.9%), specificity (12.2%, 17%) and AUC (0.273, 0.378), respectively. In non complicated pneumonia, B lines and consolidation ≥ 1cm in LUS had a good discriminative ability with sensitivity (83.9%, 71%), specificity (72.4%, 72.4%) and AUC (0.781, 0.717), respectively. In complicated pneumonia, pleural abnormality in LUS had a good discriminative ability with sensitivity 72.7%, specificity 67.3%, and AUC 0.700. In comparison, the CXR had unsatisfactory discriminative ability for detection of bronchiolitis, asthma, non complicated and complicated pneumonia with AUC 0.421, 0.561, 0.421 and 0.596, respectively.
Conclusion: Among children with lower respiratory tract infections, a positive LUS seems to distinguish between clinical diseases by ruling in pneumonia and its complication and ruling out asthma and bronchiolitis.