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Point of care ultrasound is more accurate than stethoscope
Point of care ultrasound is more accurate than traditional auscultation in the diagnosis of pneumonia in children and young adults.
A researcher at Mount Sinai reported in an article entitled “Prospective Prospective Assessment of Clinical Ultrasound in the Diagnosis of Pneumonia in Children and Adolescents” that it can even detect small pneumonia that may be missed by chest X-rays. Pediatric and Adolescent Medicine Archives, published on December 10, 2012.
These findings have important public health implications, especially in developing countries, where pneumonia is the leading cause of child deaths worldwide. Pneumonia kills about 1.2 million children under the age of five each year - more than the combined total of AIDS, malaria and tuberculosis.
“The World Health Organization estimates that as many as three-quarters of the world’s population, especially in developing countries, cannot obtain any diagnostic imaging, such as chest X-rays, to detect pneumonia,” senior author James Xie, MD Master of Public Health, Associate Professor of Emergency Medicine and Pediatrics, Mount Sinai School of Medicine. “Many children who receive antibiotics may have only viral infections – not pneumonia. Portable ultrasound machines can provide a more accurate diagnosis of pneumonia than a stethoscope.”
Dr. Tsung of Mount Sinai and Vaishali Shah, MD, of Montefiore Children's Hospital, and Michael G. Tunik, MD, of Bellevue Hospital of New York University School of Medicine, studied 200 patients born to 21 years of age. From 2008 to 2010, an emergency room for community-acquired pneumonia was suspected at the Bellevue Hospital Center. Inclusion criteria are patients who require chest X-ray assessment. The sonographer who performed and explained the ultrasound examination used ultrasound to diagnose pneumonia before the start of the study and conducted an hour of focused training.
The researchers found that point of care ultrasound to be highly specific (97 percent) for diagnosing pneumonia, with a sensitivity of up to 92%, which can be achieved through training and experience. The accuracy of using a stethoscope to diagnose pneumonia is low: the specific range is 77-83% and the sensitivity is 24%.
Further analysis of data from the Sinai Medical Center showed that of the 48 patients with confirmed pneumonia, 12 patients had a chest X-ray pneumonia that was too small (less than 1 cm).
Dr. Tsung and colleagues point out that it is more difficult to diagnose pneumonia with a stethoscope when the patient is breathing or suffering from a comorbid condition such as asthma or bronchiolitis. This is not a problem with ultrasound.
Pneumonia is an acute respiratory infection that affects the lungs. The lungs are composed of small sacs called alveoli. When a healthy person breathes, the alveoli are filled with air. When a person suffers from pneumonia, the alveoli are filled with pus and fluid, which can cause breathing pain and limit oxygen intake.