Effect of point-of-care lung ultrasound on treatment outcomes in children: A systematic review

Abstract

Background: There is interest in the use of lung ultrasound as a method to identify pneumonia and differentiate it from other causes of acute respiratory distress in children.

Aims: As part of an ERS training fellowship, we are developing a quality improvement strategy for acute respiratory illness in Kenyan children who have high mortality rates. We aimed to review evidence around clinical benefits of point-of-care ultrasound (POCUS) in respiratory illnesses in children, in both high- and limited-resource settings.

Methods: We included randomized controlled trials (RCTs) comparing POCUS with other radiological or clinical assessments, and observational studies with outcomes before and after implementation of POCUS for children with acute respiratory illness. Primary outcomes were mortality and need for oxygen supplemenation. Secondary outcomes reflected health resource utilization. Studies were identified systematically using MEDLINE, CINAHL and COCHRANE.

Results: From 140 abstracts we included one RCT and one observational study, both in developed countries. Neither study reported our primary outcome of mortality. In the RCT (n=191) availability of POCUS did not affect any clinical or health utilization outcome. In the observational study, use of POCUS reduced length of stay in the Emergency Department by around one hour (p 0.009). There was no difference in any secondary outcomes. Pooling of data for the two studies was not possible.

Conclusion: Well-designed RCTs with relevant clinical outcomes are required before POCUS is recommended in children with acute respiratory illness, especially in resource-limited settings.