Comparison of chest ultrasound to chest X-ray in the diagnosis of pneumonia in the pediatric emergency department of St Paul’s Millennium Medical College

Abstract

Abstract Background In Ethiopia, pneumonia causes over 40,000 deaths anually in children under five years old. Point-of-care lung ultrasound (LUS) is a promising radiation-free bedside tool for diagnosing pneumonia, but evidence on brief training in low-resource settings is limited(1, 2). This study evaluated the feasibility of a 2-day 6-zone LUS training for pediatric residents and compared their pneumonia detection performance to expert chest X-ray interpretations. Objective Objective - To compare the performance of LUS performed by pediatric residents in the diagnosis of pneumonia to Chest X-ray in patients evaluated in the pediatric ER of SPHMMC Methods A prospective study at SPHMMC Pediatric Emergency Department (Addis Ababa, Ethiopia) trained 7 pediatric residents in 2 days on 6-zone lung ultrasound (LUS) for pneumonia. Seventy one children (age >2 months to <14 years) with suspected pneumonia underwent resident performed LUS as well as Chest X ray . Results were compared and agreement was evaluated using concordance, sensitivity/specificity, kappa for key LUS findings. Results In this prospective study 71 children (>2 months to <14 years; mean age 37 ± 42 months) with suspected pneumonia received LUS and Chest X ray. Chest Xray, read by two radiologists, confirmed pneumonia in 69% of cases (radiological confirmed ). Residents reported image acquisition difficulty in 63% of cases, with mean scan time of 17.8 minutes. Resident-performed LUS showed fair agreement with Chest Xray (69% concordance, κ=0.38, p<0.001), sensitivity 96%, specificity 38%, PPV 77%, NPV 80%, and overall accuracy 77%. Conclusion While the overall accuracy of LUS performed by pediatric residents who had brief training was only moderate, the high sensitivity and moderate NPV strongly support LUS for ruling out pneumonia and guiding initial management. Resident inexperience likely reduced LUS specificity and agreement with Chest x ray compared to expert studies. However, These findings suggest that intensified, large-scale training could establish LUS as a reliable diagnostic alternative in resource-limited settings like Ethiopia, where radiology access is limited.