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Comparison of chest radiograph and lung ultrasound in children with acute respiratory failure

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Abstract

Purpose

Chest x-ray (CXR) is the standard imaging used to evaluate children in acute respiratory distress and failure. Our objective was to compare the lung-imaging techniques of CXR and lung ultrasound (LUS) in the evaluation of children with acute respiratory failure (ARF) to quantify agreement and to determine which technique identified a higher frequency of pulmonary abnormalities.

Methods

This was a secondary analysis of a prospective observational study evaluating the sensitivity and specificity of LUS in children with ARF from 12/2018 to 02/2020 completed at the University of Wisconsin-Madison (USA). Children > 37.0 weeks corrected gestational age and ≤ 18 years of age admitted to the PICU with ARF were evaluated with LUS. We compared CXR and LUS completed within 6 h of each other. Kappa statistics (k) adjusted for maximum attainable agreement (k/kmax) were used to quantify agreement between imaging techniques and descriptive statistics were used to describe the frequency of abnormalities.

Results

Eighty-eight children had LUS completed, 32 with concomitant imaging completed within 6 h are included. There was fair agreement between LUS and CXR derived diagnoses with 58% agreement (k/kmax = 0.36). Evaluation of imaging patterns included: normal, 57% agreement (k = 0.032); interstitial pattern, 47% agreement (k = 0.003); and consolidation, 65% agreement (k = 0.29). CXR identified more imaging abnormalities than LUS.

Conclusions

There is fair agreement between CXR and LUS-derived diagnoses in children with ARF. Given this, clinicians should consider the benefits and limitations of specific imaging modalities when evaluating children with ARF. Additional studies are necessary to further define the role of LUS in pediatric ARF given the small sample size of our study.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AP:

Anterior–posterior

ARF:

Acute respiratory failure

BLUE:

Bedside lung ultrasound in emergency protocol

CT:

Computerized tomography

CXR:

Chest x-ray

HFNC:

High flow nasal cannula

LUS:

Lung ultrasound

PICU:

Pediatric intensive care unit

SPC:

Subpleural consolidation

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Acknowledgements

We would like to thank Drs. Hagen and Allen for their guidance in the production of this project, the nurses for their enthusiasm and support of this research, and the families and patients at the University of Wisconsin-Madison for their willingness to participate.

Prior presentation

Study data were presented at the Society of Critical Care Medicine (SCCM) Annual Congress (2022 April 18; virtual conference).

Funding

This project was supported by the Clinical and Translational Science Award (CTSA) program through the NIH National Center for Advancing Translational Sciences (NCATS), Grant UL1TR002373. The content of the work and manuscript are solely the responsibility of the authors and do not represent the views of the NIH. The funding source had no involvement in the study design; collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the article for publication. The authors have declared no other sources of funding related to this work.

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Authors and Affiliations

  1. Department of Pediatrics, Drexel College of Medicine, St Christopher’s Hospital for Children, Philadelphia, PA, USA

    Ryan L. DeSanti

  2. Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Kara G. Gill & Jonathan O. Swanson

  3. Department of Medicine, Advocate Aurora Health Care, St Luke’s Medical Center, Milwaukee, WI, USA

    Pierre D. Kory

  4. Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Jessica Schmidt

  5. Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Eileen A. Cowan & Awni M. Al-Subu

  6. Department of Biostatistics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Michael R. Lasarev

  7. Department of Critical Care Medicine, St Christopher’s Hospital for Children, 160 East Erie Avenue, Third Floor Suite, Office A3-20k, Philadelphia, PA, 19143, USA

    Ryan L. DeSanti

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  1. Ryan L. DeSanti
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Contributions

Ryan DeSanti, Awni Al-Subu, and Pierre Kory contributed to the conception of the study, data acquisition, analysis and interpretation, work drafting and gave final approval of the version to be published. Kara Gill; Jonathan Swanson, Jessica Schmidt, and Eileen Cowan contributed to data acquisition, work drafting and gave final approval of the version to be published. Michael Lasarev contributed to data analysis and interpretation, work drafting and gave final approval of the version to be published. Ryan DeSanti is the guarantor of the paper, had full access to all study data, and takes responsibility for the integrity of the data and accuracy of analysis, from inception to published article.

Corresponding author

Correspondence to Ryan L. DeSanti.

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Conflict of interest

Dr. Al-Subu has a consulting agreement with Edwards Lifesciences LLC. The remaining authors have declared no conflicts of interest related to this work.

Study location, ethical approval, and consent to participate

This study was completed at The American Family Children’s Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. The Institutional Review Board at the University of Wisconsin-Madison approved this study (IRB 2018-071). Signed, informed parent/guardian consent, and assent when appropriate was obtained for participants. The study was registered with ClinicalTrials.gov (NCT03744169).

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DeSanti, R.L., Gill, K.G., Swanson, J.O. et al. Comparison of chest radiograph and lung ultrasound in children with acute respiratory failure. J Ultrasound 26, 861–870 (2023). https://doi.org/10.1007/s40477-023-00827-y

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