TY - JOUR
T1 - An algorithm combining procalcitonin and lung ultrasound improves the diagnosis of bacterial pneumonia in critically ill children
T2 - The PROLUSP study, a randomized clinical trial
AU - Guitart, Carmina
AU - Rodríguez-Fanjul, Javier
AU - Bobillo-Perez, Sara
AU - Carrasco, José L.
AU - Inarejos Clemente, Emilio J.
AU - Cambra, Francisco J.
AU - Balaguer, Mònica
AU - Jordan, Iolanda
N1 - Funding Information:
Authors would like to thank children and families, who agreed being a part of the PROLUSP study. This study has been funded by Instituto de Salud Carlos III through the project “PI16/01040” (Co‐funded by European Regional Development Fund/European Social Fund “A way to make Europe”/“Investing in your future”).
Publisher Copyright:
© 2021 Wiley Periodicals LLC.
PY - 2022/3
Y1 - 2022/3
N2 - Background: Lung ultrasound (LUS) and procalcitonin (PCT) are independently used to improve accuracy when diagnosing lung infections. The aim of the study was to evaluate the accuracy of a new algorithm combining LUS and PCT for the diagnosis of bacterial pneumonia. Methods: Randomized, blinded, comparative effectiveness clinical trial. Children <18 years old with suspected pneumonia admitted to pediatric intensive care unit were included, and randomized into experimental group (EG) or control group (CG) if LUS or chest X-Ray (CXR) were done as the first pulmonary image, respectively. PCT was determined. In patients with bacterial pneumonia, sensitivity, specificity, and predictive values of LUS, CXR, and of both combined with PCT were analyzed and compared. Concordance between the final diagnosis and the diagnosis concluded through the imaging test was assessed. Results: A total of 194 children, with a median age of 134 (interquartile range [IQR]: 39–554) days, were enrolled, 96 randomized into the EG and 98 into the CG. Bacterial pneumonia was diagnosed in 97 patients. Sensitivity and specificity for bacterial pneumonia diagnosis were 78% (95% confidence interval [CI]: 70–85) and 98% (95% CI: 93–99) for LUS, 85% (95% CI: 78–90) and 53% (95% CI: 43–62) for CXR, 90% (95% CI: 83–94) and 85% (95% CI: 76–91) when combining LUS and PCT, and 95% (95% CI: 90–98) and 41% (95% CI: 31–52) when combining CXR and PCT. The positive predictive value for LUS and PCT was 88% (95% C:I 79%–93%) versus 68% (95% CI: 60–75) for CXR and PCT. The concordance between the final diagnosis and LUS had a kappa value of 0.69 (95% CI: 0.62–0.75) versus 0.34 (95% CI: 0.21–0.45) for CXR, (p < 0.001). Conclusions: The combination of LUS and PCT presented a better accuracy for bacterial pneumonia diagnosis than combining CXR and PCT. Therefore, its implementation could be a reliable tool for pneumonia diagnosis in critically ill children.
AB - Background: Lung ultrasound (LUS) and procalcitonin (PCT) are independently used to improve accuracy when diagnosing lung infections. The aim of the study was to evaluate the accuracy of a new algorithm combining LUS and PCT for the diagnosis of bacterial pneumonia. Methods: Randomized, blinded, comparative effectiveness clinical trial. Children <18 years old with suspected pneumonia admitted to pediatric intensive care unit were included, and randomized into experimental group (EG) or control group (CG) if LUS or chest X-Ray (CXR) were done as the first pulmonary image, respectively. PCT was determined. In patients with bacterial pneumonia, sensitivity, specificity, and predictive values of LUS, CXR, and of both combined with PCT were analyzed and compared. Concordance between the final diagnosis and the diagnosis concluded through the imaging test was assessed. Results: A total of 194 children, with a median age of 134 (interquartile range [IQR]: 39–554) days, were enrolled, 96 randomized into the EG and 98 into the CG. Bacterial pneumonia was diagnosed in 97 patients. Sensitivity and specificity for bacterial pneumonia diagnosis were 78% (95% confidence interval [CI]: 70–85) and 98% (95% CI: 93–99) for LUS, 85% (95% CI: 78–90) and 53% (95% CI: 43–62) for CXR, 90% (95% CI: 83–94) and 85% (95% CI: 76–91) when combining LUS and PCT, and 95% (95% CI: 90–98) and 41% (95% CI: 31–52) when combining CXR and PCT. The positive predictive value for LUS and PCT was 88% (95% C:I 79%–93%) versus 68% (95% CI: 60–75) for CXR and PCT. The concordance between the final diagnosis and LUS had a kappa value of 0.69 (95% CI: 0.62–0.75) versus 0.34 (95% CI: 0.21–0.45) for CXR, (p < 0.001). Conclusions: The combination of LUS and PCT presented a better accuracy for bacterial pneumonia diagnosis than combining CXR and PCT. Therefore, its implementation could be a reliable tool for pneumonia diagnosis in critically ill children.
KW - critical care
KW - lung ultrasound
KW - pediatrics
KW - pneumonia
KW - procalcitonin
UR - https://www.scopus.com/pages/publications/85122060792
U2 - 10.1002/ppul.25790
DO - 10.1002/ppul.25790
M3 - Article
C2 - 34921717
AN - SCOPUS:85122060792
SN - 8755-6863
VL - 57
SP - 711
EP - 723
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
IS - 3
ER -