Lung ultrasound in diagnosis of wheezing triggered by infection in children less than 2 years: An observational study.

OBJECTIVES

Lung ultrasound (LUS) has emerged as a potential tool in diagnosis of lower respiratory tract infections (LRTIs). This study aimed to evaluate its role in the differential diagnosis of LRTIs with respiratory distress and wheezing in children less than 2 years.

METHODS

A exploratory, prospective, observational, multicentre study was conducted involving children less than 2 years with LRTIs and respiratory distress. LUS was performed within 24 h of admission. Findings were scored from 0 to 4 based on the type and severity of lesions observed in each of five defined areas and summed to calculate overall lung involvement. Main outcome was final clinical diagnosis (bronchiolitis or recurrent wheezing triggered by LRTI). The effect size, the predictive performance (ROC-AUC), sensitivity (S), and specificity (E) were calculated.

RESULTS

99 patients were included. Pathological LUS findings were present in 84.8%. Its presence in the right posterior lung fields was more frequently observed in clinical bronchiolitis (effect size: 0.674). These findings showed for this diagnosis a ROC-AUC of 0.68 (95% CI: 0.57-0.80) for the entire sample. For patients >6 months ROC-AUC was 0.81 (95% CI: 0.65-0.97), with 50% sensitivity and 96% specificity for the presence of >3 B-lines in this subgroup.

CONCLUSIONS

LUS could help differentiate bronchiolitis from wheezing triggered by LRTIs in young children (especially in >6 months). The presence of B-lines in certain lung fields may be of diagnostic value. Variability in image acquisition and interpretation poses challenges. Larger studies are needed to confirm these findings and to establish an objective scale.