Multicentre pilot study evaluation of lung ultrasound for the management of paediatric pneumonia in low-resource settings: a study protocol

Jennifer L Lenahan, Giovanni Volpicelli, Alessandro Lamorte, Fyezah Jehan, Quique Bassat, Amy Sarah Ginsburg, Jennifer L Lenahan, Giovanni Volpicelli, Alessandro Lamorte, Fyezah Jehan, Quique Bassat, Amy Sarah Ginsburg

Abstract

Introduction: Pneumonia is the leading infectious cause of death among children under 5 years of age worldwide. However, pneumonia is challenging to diagnose. Lung ultrasound (LUS) is a promising diagnostic technology. Further evidence is needed to better understand the role of LUS as a tool for the diagnosis of childhood pneumonia in low-resource settings.

Methods and analysis: This study aims to pilot LUS in Mozambique and Pakistan and to generate evidence regarding the use of LUS as a diagnostic tool for childhood pneumonia. Children with cough <14 days with chest indrawing (n=230) and without chest indrawing (n=40) are enrolled. World Health Organization Integrated Management of Childhood Illness assessment is performed at enrolment, along with a chest radiograph and LUS examination. Respiratory and blood specimens are collected for viral and bacterial testing and biomarker assessment. Enrolled children are followed for 14 days (in person) and 30 days (phone call) post-enrolment with LUS examinations performed on Days 2, 6 and 14. Qualitative and quantitative data are also collected to assess feasibility, usability and acceptability of LUS among healthcare providers and caregivers. The primary outcome is LUS findings at enrolment with secondary outcomes including patient outcomes, repeat LUS findings, viral and bacterial test results, and patient status after 14 and 30 days of follow-up.

Ethics and dissemination: This trial was approved by the Western Institutional Review Board as well as local ethics review committees at each site. We plan to disseminate study results in peer-reviewed journals and international conferences.

Trial registration number: NCT03187067.

Keywords: imaging/CT MRI etc; paediatric lung disaese; pneumonia; respiratory infection.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Map of study areas.

References

    1. Liu L, Oza S, Hogan D, et al. . Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015;385:430–40. 10.1016/S0140-6736(14)61698-6
    1. UNICEF Pneumonia claims the lives of the world’s most vulnerable children. UNICEF Data: Monitoring the situation of women and children. New York: UNICEF Data, 2018.
    1. WHO Integrated management of childhood illness: chart booklet. Geneva: World Health Organization, 2014.
    1. Mackenzie G. The definition and classification of pneumonia. Pneumonia 2016;8:14 10.1186/s41479-016-0012-z
    1. Pereda MA, Chavez MA, Hooper-Miele CC, et al. . Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics 2015;135:714–22. 10.1542/peds.2014-2833
    1. Cortellaro F, Colombo S, Coen D, et al. . Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J 2012;29:19–23. 10.1136/emj.2010.101584
    1. Ellington LE, Gilman RH, Chavez MA, et al. . Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings. Respir Med 2017;128:57–64. 10.1016/j.rmed.2017.05.007
    1. Ambroggio L, Sucharew H, Rattan MS, et al. . Lung ultrasonography: a viable alternative to chest radiography in children with suspected pneumonia? J Pediatr 2016;176:93–8. 10.1016/j.jpeds.2016.05.033
    1. Balk DS, Lee C, Schafer J, et al. . Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: A meta-analysis. Pediatr Pulmonol 2018;53:1130–9. 10.1002/ppul.24020
    1. Amatya Y, Rupp J, Russell FM, et al. . Diagnostic use of lung ultrasound compared to chest radiograph for suspected pneumonia in a resource-limited setting. Int J Emerg Med 2018;11:8 10.1186/s12245-018-0170-2
    1. Xin H, Li J, Hu HY. Is lung ultrasound useful for diagnosing pneumonia in children?: a meta-analysis and systematic review. Ultrasound Q 2018;34:3–10. 10.1097/RUQ.0000000000000330
    1. Cherian T, Mulholland EK, Carlin JB, et al. . Standardized interpretation of paediatric chest radiographs for the diagnosis of pneumonia in epidemiological studies. Bull World Health Organ 2005;83:353–9.
    1. Mahomed N, Fancourt N, de Campo J, et al. . Preliminary report from the world health organisation chest radiography in epidemiological studies project. Pediatr Radiol 2017;47:1399–404. 10.1007/s00247-017-3834-9
    1. Fancourt N, Deloria Knoll M, Barger-Kamate B, et al. . Standardized interpretation of chest radiographs in cases of pediatric pneumonia from the PERCH Study. Clin Infect Dis 2017;64 S253–61. 10.1093/cid/cix082
    1. Harris PA, Taylor R, Thielke R, et al. . Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. United States Central Intelligence Agency Pakistan [Political]. Map. 1:10,000,000. Texas: University of Texas Libraries, Perry-Castañeda Library Map Collection, 2010.
    1. United States Central Intelligence Agency Mozambique [Political]. Map. Scale not given. Texas: University of Texas Libraries, Perry-Castañeda Library Map Collection, 1995.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren