Amy Sarah Ginsburg1, Jennifer L Lenahan2, Fyezah Jehan3, Rubao Bila4, Alessandro Lamorte5, Jun Hwang1, Lola Madrid6, Muhammad Imran Nisar3, Pio Vitorino4, Neel Kanth7, Reyes Balcells6, Benazir Baloch3, Susanne May1, Marta Valente6, Rosauro Varo6, Naila Nadeem8, Quique Bassat4,6,9,10,11, Giovanni Volpicelli12. 1. Clinical Trial Center, University of Washington, Seattle, Washington, USA. 2. Save the Children Federation, Inc., Seattle, Washington, USA. 3. Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. 4. Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique. 5. Department of Emergency Medicine, Parini Hospital, Aosta, Italy. 6. ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 7. Sindh Government Children's Hospital-Poverty Eradication Initiative, Karachi, Pakistan. 8. Department of Radiology, Aga Khan University, Karachi, Pakistan. 9. Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain. 10. Department of Pediatrics, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain. 11. Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain. 12. Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Italy.
Abstract
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.
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.
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