Objective
Lung ultrasound (LUS) is an alternative to chest radiography to confirm a diagnosis
of pneumonia. For research and disease surveillance, methods to use LUS to diagnose
pneumonia are needed.
Methods
In the Household Air Pollution Intervention Network (HAPIN) trial, LUS was used to
confirm a clinical diagnosis of severe pneumonia in infants. We developed a standardized
definition of pneumonia, protocols for recruitment and training of sonographers, along
with LUS image acquisition and interpretation. We use a blinded panel approach to
interpretation with LUS cine-loops randomized to non-scanning sonographers with expert
review.
Discussion
We obtained 357 lung ultrasound scans: 159, 8 and 190 scans were collected in Guatemala,
Peru and Rwanda, respectively. The diagnosis of primary endpoint pneumonia (PEP) required
an expert tie breaker in 181 scans (39%). PEP was diagnosed in 141 scans (40%), not
diagnosed in 213 (60%), with 3 scans (<1%) deemed uninterpretable. Agreement among
the two blinded sonographers and the expert reader in Guatemala, Peru and Rwanda was
65%, 62% and 67%, with a prevalence-and-bias-corrected kappa of 0.30, 0.24 and 0.33,
respectively.
Conclusion
Use of standardized imaging protocols, training and an adjudication panel resulted
in high confidence for the diagnosis of pneumonia using LUS.
Keywords
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Article info
Publication history
Published online: February 18, 2023
Accepted:
January 3,
2023
Received in revised form:
December 23,
2022
Received:
June 23,
2022
Identification
Copyright
© 2023 World Federation for Ultrasound in Medicine & Biology. All rights reserved.
