Lung ultrasound to detect pneumothorax in children evaluated for acute chest pain in the emergency department: a prospective study
We addressed the accuracy of Lung Ultrasound (LUS) to detect pneumothorax in children with acute chest pain evaluated in the pediatric Emergency Department (pED). Methods We prospectively analyzed patients from 5 to 17 years of age with acute chest pain and clinical suspicion of pneumothorax (PNX) evaluated at a tertiary level pediatric hospital. After clinical examination and before Chest X-Ray (CXR), children underwent LUS to evaluate the presence of PNX. Results We enrolled 77 children, 44 (57,1 %) male, with median age of 10 years and 3 months (IQR 6 years and 9 months - 14 years and 2 months). Thirty (39%) children had interstitial lung disease; 20/77 (26%) had pneumonia with or without pleural effusions; 7/77 (9,1%) had thoracic trauma; 7/77 (9,1%) had a final diagnosis of myo/pericarditis and 13 (16,9%) received a final diagnosis of PNX. In all 13 patients LUS showed the “bar-code sign” while in 12 (92,3%) there was the lung point, giving a diagnosis of PNX. All cases were confirmed by CXR. The lung point had a sensitivity of 92,3% and a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 98,4 % for the detection of PNX. The “bar-code sign” had a sensitivity of 100% and a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 100% for the detection of PNX. Conclusions LUS is highly accurate in detecting or excluding pneumothorax in children with acute chest pain evaluated in the pediatric emergency department. Importantly, both lung-point and M-mode need to be performed when PNX is suspected.
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Statistical analysis was performed using the SPSS software (IBM SPSS Statistics, version 24.0, Chicago, IL, USA). Values were expressed as arithmetic means ± standard deviation (SD) for continuous variables normally distributed, median and interquartile range (IQR) for not normally distributed data, or number and percentage (%) for categorical variable. Concordance between US and CXR was established with Cohen’s kappa index. A p-value <0.05 was considered statistically significant.