Transthoracic Ultrasound versus Chest Radiography for Early Diagnosis of Pleural Effusion in Children A Comparative Study

Salma Gamal AbdelHafeez AbdelHady


Abstract


TUS has a growing reputation for being a powerful bedside tool that is superior to physical examination and chest radiographs in the detection and characterization of pleural effusions. However, the routine use of TUS for bed side diagnosis of pleural effusion remains low in the current clinical practice. This study was designed to evaluate the value of TUS in the early diagnosis of pleural effusion among clinically anticipated cases compared to physical examination and CXR (AP & lateral views). Our study was conducted on 50 children whom we had a clinical anticipation of PE, they were recruited from the Children’s hospital, Ain Shams University Hospitals, during the year 2016. Their age ranged between 4 months and 15 years with mean age of 3.29(±3.29) years. We compared findings from bedside TUS, CXR (AP & lateral view) and examination in all the patients. We measured the ability of each of these diagnostic modalities to detect pleural effusion. All the patients enrolled in the study were subjected to detailed history taking, thorough physical examination followed by TUS and finally CXR (AP and lateral views). The prevalence of pleural effusion in the whole study population was 58%. PE (by TUS) was more common in males (69%) in comparison to females (31%). Bronchopneumonia was the leading cause of PE among the study group (51%). There is limited evidence in the literature on the accuracy and reliability of symptoms and signs for the clinical diagnosis of pleural effusion in pediatrics. So, we did an independent comparison of the symptoms, physical signs and the laboratory data with the reference standard (TUS). We performed multivariate analysis to identify the symptoms, clinical signs and laboratory data that independently predicted pleural effusion among our study group. The final multivariate model showed the symptoms and signs that predicted the presence of PE among the study group were high grade fever, Retractions (grade 2 RD), asymmetric chest expansion and dull percussion note. Laboratory criteria that predicted the presence of pleural effusion among the study group were serum albumin<3.1 g/dL, CRP level>48 (mg/dl), TLC level >16(103/uL) and serum hemoglobin level<9.8 gm/dL. Agreement statistics showed that there was a moderate agreement between TUS and physical examination in detecting PE. In addition, there was a slight agreement between TUS & CXR (both AP and lateral views). Lastly, there was a slight agreement between physical examination and CXR (both AP and lateral views) in detecting PE. Our study showed there is a positive correlation between the estimated PE volume by TUS with the weight and CRP level bilaterally. Also, there is a positive correlation between duration of symptoms before hospital admission (days), and the PE volume on the left side. The Other studied parameters were insignificant. Our study showed that physical examination detected more pleural effusions than both CXR AP and lateral views. Calculated diagnostic accuracy in detecting PE of the previous three modalities compared to the TUS were 82.2%, 52% and 46% respectively. In addition, CXR lateral view had a higher diagnostic accuracy than CXR AP view in detecting pleural effusions (52% & 46% respectively).


Other data

Other Titles دور الأشعة التلفزيونية على الصدر فى التشخيص المبكر للإرتشاح البلوري مُقارنةً بالأشعة السينيه فى الأطفال
Issue Date 2017
URI http://research.asu.edu.eg/handle/12345678/2572


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