Application Of Lung Ultrasound In The Evaluation Of Community-acquired Pneumonia In Children

Objective:to explore the clinical value of lung ultrasound in the diagnosis and initial treatment of severe pneumonia in children with community-acquired pneumonia.Methods:children diagnosed with community-acquired pneumonia from 1 to 60 months in General Hospital of Ningxia Medical University were scanned by lung ultrasound within24 hours after admission.The difference of lung ultrasound findings between severe pneumonia and non-severe pneumonia was analyzed,and the lung ultrasound score was calculated.The diagnostic value of lung ultrasound score in severe pneumonia was evaluated by ROC curve,and the correlation between lung ultrasound score and clinical indexes was analyzed.The children with severe pneumonia were scanned again 48 hours after treatment to analyze the changes of lung ultrasound signs in the early stage of treatment and to explore the clinical value of lung ultrasound score in the evaluation of initial treatment effect.Results:lung ultrasonography was performed in 113 children with community-acquired pneumonia,including severe group（n=53）and non-severe group（n=60）.The distribution of lesions in areas 5 and 6 was 53%in the severe group and 57%in the non-severe group.The distribution of lesions in both the severe group and the non-severe group was mostly located in the posterior lung region.The median number of lesions involved in the lung region in the severe group was 7.0（6.0,8.5）,which was more than 2.0（2.0,4.0）in the non-severe group,and the difference was statistically significant（P<0.01）.The ultrasonographic positive findings in the non-severe group were mainly B-line changes,while there were more consolidation changes in the severe group,and pleural effusion occurred in the severe group,and the lung ultrasound score in the severe group was 14.6±3.9,which was significantly higher than that in the non-severe group（5.1±5.3）（P<0.01）.The area under the curve of lung ultrasound score for the diagnosis of severe pneumonia was 0.984,with 8.5 points as the cutoff value.The sensitivity and specificity of lung ultrasound in the diagnosis of severe pneumonia were 94.3%and 91.9%,respectively.The lung ultrasound score of children with severe pneumonia was negatively correlated with oxygenation index（PO₂/FIO₂）（r=-0.516,P<0.01）,positively correlated with PCO₂（r=0.605,P<0.01）,and had no significant correlation with white blood cell count,neutrophil percentage and C-reactive protein（P>0.05）.After initial treatment,the changes of lung ultrasound signs were mainly interstitial changes（B-line）.Lung ultrasound score was used to evaluate the condition after initial treatment,with a sensitivity of 93%and a specificity of 88%.Conclusion:lung ultrasound can evaluate the severity of CAP in children by ultrasonic signs and lung ultrasound scores.It has high clinical value in diagnosing severe pneumonia and evaluating the initial treatment effect of severe pneumonia,and can be used as a new method to evaluate the disease in clinical diagnosis and treatment decision-making.