Efficacy of bed side lung ultrasound for detection of lung pathologies in PICU.

Abstract

Objective: To evaluate the diagnostic accuracy of bedside lung ultrasound (LUS) compared with chest X-ray for detecting common lung pathologies among critically ill children. Study Design: Cross-sectional, Analytical, Diagnostic Accuracy study. Setting: Pediatric Intesive Care Unit (PICU) of the National Institute of Child Health, Karachi, Pakistan. Period: October 2024 to March 2025. Methods: A total of 52 children aged 1 month to 15 years, with respiratory distress, or developing new respiratory signs during PICU stay were analyzed. Bedside LUS was performed using a standardized protocol, with operators blinded to chest X-ray findings. Chest X-ray interpreted by radiology served as the reference standard. Diagnostic performance was assessed using McNemar test, taking p<0.05 as significant. Results: In a total of 52 children, 34 (65.4%) were males. The median age was 3.0 (IQR 1.4-6.0) years. Bedside LUS identified pneumonia or consolidation in 32 (61.5%) children, while chest X-ray reported in 38 (73.1%). Pleural effusion was detected on LUS in 24 (46.2%) children, and on chest X-ray in 21 (40.4%). Pneumothorax was documented in 6 (11.5%) children on both modalities. Pulmonary edema or interstitial syndrome was observed in 8 (15.4%) children on ultrasound, and in 8 (15.4%) children on chest X-ray. Using paired comparison, there was no significant difference between bedside LUS and CXR in detection rates of pneumonia/consolidation (p=0.109), pleural effusion (p=0.453), pneumothorax (p=1.000) or pulmonary edema/interstitial syndrome (p=1.000). Conclusion: Bedside LUS demonstrated clinically meaningful diagnostic performance in critically ill children for pneumothorax, pleural effusion, pulmonary edema or interstitial syndrome, and pneumonia or consolidation.