1921
Volume 101, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings. Our goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) between COs and experts for lung consolidation with air bronchograms was 0.73 (0.63–0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74–0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. United Nations Children’s Fund, 2017. Pneumonia: Current Status + Progress. Available at: https://data.unicef.org/topic/child-health/pneumonia/#. Accessed December 26, 2017. [Google Scholar]
  2. Malaria Consortium, 2017. Pneumonia Diagnostics. Available at: http://www.malariaconsortium.org/projects/pneumonia-diagnostics/15/south-sudan. Accessed December 26, 2017. [Google Scholar]
  3. Rambaud-Althaus C, Althaus F, Genton B, D’Acremont V, , 2015. Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis. Lancet Infect Dis 15: 439450. [Google Scholar]
  4. Hazir T, Nisar YB, Qazi SA, Khan SF, Raza M, Zameer S, Masood SA, , 2006. Chest radiography in children aged 2–59 months diagnosed with non-severe pneumonia as defined by World Health Organization: descriptive multicentre study in Pakistan. BMJ 333: 629631. [Google Scholar]
  5. Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK, , 2016. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 21: 294311. [Google Scholar]
  6. Monti JD, Younggren B, Blankenship R, , 2009. Ultrasound detection of pneumothorax with minimally trained sonographers: a preliminary study. J Spec Oper Med 9: 4346. [Google Scholar]
  7. Zhan C, Grundtvig N, Klug BH, , 2018. Performance of bedside lung ultrasound by a pediatric resident: a useful diagnostic tool in children with suspected pneumonia. Pediatr Emerg Care 34: 618622. [Google Scholar]
  8. Lissaman C, Kanjanauptom P, Ong C, Tessaro M, Long E, O’Brien A, , 2019. Prospective observational study of point-of-care ultrasound for diagnosing pneumonia. Arch Dis Child 104: 1218. [Google Scholar]
  9. Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, Gross M, Price C, Tielsch JM, Checkley W, , 2015. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics 135: 714722. [Google Scholar]
  10. Reali F, Sferrazza Papa GF, Carlucci P, Fracasso P, Di Marco F, Mandelli M, Soldi S, Riva E, Centanni S, , 2014. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children? Respiration 88: 112115. [Google Scholar]
  11. Chavez MA, Naithani N, Gilman RH, Tielsch JM, Khatry S, Ellington LE, Miranda JJ, Gurung G, Rodriguez S, Checkley W, , 2015. Agreement between the World Health Organization algorithm and lung consolidation identified using point-of-care ultrasound for the diagnosis of childhood pneumonia by general practitioners. Lung 193: 531538. [Google Scholar]
  12. Sanyahumbi AS, Sable CA, Karlsten M, Hosseinipour MC, Kazembe PN, Minard CG, Penny DJ, , 2017. Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa. Cardiol Young 27: 11331139. [Google Scholar]
  13. Federspiel F, Mukhopadhyay S, Milsom PJ, Scott JW, Riesel JN, Meara JG, , 2018. Global surgical, obstetric, and anesthetic task shifting: a systematic literature review. Surgery 164: 553558. [Google Scholar]
  14. Tsung JW, Kessler DO, Shah VP, , 2012. Prospective application of clinician-performed lung ultrasonography during the 2009 H1N1 influenza A pandemic: distinguishing viral from bacterial pneumonia. Crit Ultrasound J 4: 16. [Google Scholar]
  15. Volpicelli G, International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS) , 2012. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38: 577591. [Google Scholar]
  16. Shah SP, Shah SP, Fils-Aime R, Desir W, Joasil J, Venesy DM, Muruganandan KM, , 2016. Focused cardiopulmonary ultrasound for assessment of dyspnea in a resource-limited setting. Crit Ultrasound J 8: 7. Available at: https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-016-0043-y. [Google Scholar]
  17. American College of Emergency Physicians, 2011. Emergency Ultrasound Standard Reporting Guidelines 2011. Available at: https://www.acep.org/globalassets/uploads/uploaded-files/acep/by-medical-focus/ultrasound/eus_srgs_111511_edited0116.pdf. Accessed November 1, 2016. [Google Scholar]
  18. Shah VP, Tunik MG, Tsung JW, , 2013. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr 167: 119125. [Google Scholar]
  19. Ellington LE, 2017. Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings. Respir Med 128: 5764. [Google Scholar]
  20. Jones BP, Tay ET, Elikashvili I, Sanders JE, Paul AZ, Nelson BP, Spina LA, Tsung JW, , 2016. Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest 150: 131138. [Google Scholar]
  21. Bossuyt PM, 2015. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Clin Chem 61: 14461452. [Google Scholar]
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Supplemental appendices

  • Received : 12 Sep 2018
  • Accepted : 14 Jun 2019
  • Published online : 08 Jul 2019

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