TY - JOUR
T1 - Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan
AU - Ginsburg, Amy Sarah
AU - Lenahan, Jennifer L.
AU - Jehan, Fyezah
AU - Bila, Rubao
AU - Lamorte, Alessandro
AU - Hwang, Jun
AU - Madrid, Lola
AU - Nisar, Muhammad Imran
AU - Vitorino, Pio
AU - Kanth, Neel
AU - Balcells, Reyes
AU - Baloch, Benazir
AU - May, Susanne
AU - Valente, Marta
AU - Varo, Rosauro
AU - Nadeem, Naila
AU - Bassat, Quique
AU - Volpicelli, Giovanni
N1 - Funding Information:
Higher interoperator and interrater reliability for LUS interpretation than for CXR interpretation in identifying pediatric pneumonia is supported by the literature (Figure 4 ). We contrasted kappas observed in this study with kappas observed in the literature among other LUS and CXR interpreters. Kappas between LUS interpreters were 0.900 (in Pakistan) and 0.917 (in Mozambique) in this study (expert LUS interpreters) and ranged from 0.635 to 0.930 in the literature, whereas kappa between CXR interpreters ranged from −0.04 to 0.62 in this study and from 0.35 to 0.74 in the literature. 14,16–33
Funding Information:
This study was supported by grants from the Bill and Melinda Gates Foundation (OPP1105080) and Save the Children. The authors would like to thank the dedicated study staff at Manhiça District Hospital in Manhiça, Mozambique and Sindh Government Children's Hospital–Poverty Eradication Initiative in Karachi, Pakistan for implementing the study and providing patient care. They would also like to thank Adelina Malembe and Zumilda A. Boca in Mozambique and Fariha Sohail and Zunera Qasim in Pakistan for conducting and interpreting the LUS exams. They would like to thank Campos Mucasse and Vania Afuale in Mozambique and Farrukh Abbasi, Zehra Aziz, Ghazala Sheikh, and Naveed Ahmad in Pakistan for general coordination and support of the study. At last, they would like to thank the trial participants, their caregivers, and the local community in Manhiça and Karachi for their participation and support. In addition, the authors would like to acknowledge Nick Fancourt and Steve Lacey for their technical guidance in the chest radiograph (CXR) portion of the study, and the expert panel of CXR interpreters—Rachel Benamore, Vera Manduku, Eric McCollum, Kate Park, Joyce Sande, and Pui-Ying Iroh Tam, as well as Angelo Giovanni Del Monaco for providing lung ultrasound (LUS) arbitration. They would also like to acknowledge Lilliam Ambroggio for her guidance in developing the standardized LUS and CXR forms.
Publisher Copyright:
© 2020 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC
PY - 2021/2
Y1 - 2021/2
N2 - Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. Methods: We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. Results: Interrater reliability was excellent for expert LUS interpreters, but poor to moderate for expert CXR interpreters and onsite LUS interpreters with limited training. Conclusions: Among children with WHO IMCI chest-indrawing pneumonia, expert interpreters may achieve substantially higher interrater reliability for LUS compared to CXR, and LUS showed potential as a preferred reference standard. For point-of-care LUS to be successfully implemented for the diagnosis and management of pneumonia in LRS, the clinical environment and amount of appropriate user training will need to be understood and addressed.
AB - Introduction: Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. Methods: We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. Results: Interrater reliability was excellent for expert LUS interpreters, but poor to moderate for expert CXR interpreters and onsite LUS interpreters with limited training. Conclusions: Among children with WHO IMCI chest-indrawing pneumonia, expert interpreters may achieve substantially higher interrater reliability for LUS compared to CXR, and LUS showed potential as a preferred reference standard. For point-of-care LUS to be successfully implemented for the diagnosis and management of pneumonia in LRS, the clinical environment and amount of appropriate user training will need to be understood and addressed.
KW - chest ultrasound
KW - childhood pneumonia
KW - interrater reliability
KW - low-resource settings
UR - http://www.scopus.com/inward/record.url?scp=85096676469&partnerID=8YFLogxK
U2 - 10.1002/ppul.25176
DO - 10.1002/ppul.25176
M3 - Article
C2 - 33205892
AN - SCOPUS:85096676469
SN - 8755-6863
VL - 56
SP - 551
EP - 560
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
IS - 2
ER -