Observational studyItalian journal of pediatrics2026
Lung ultrasound versus chest X-ray in pediatric lower respiratory tract infections at a tertiary center: a prospective observational study.
Observational study in Italian journal of pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLower respiratory tract infections (LRTIs) are a major cause of morbidity in children. While chest X-ray (CXR) is widely used for diagnosis, it has limitations including radiation exposure and suboptimal sensitivity. Lung ultrasound (LUS) is an emerging rapid, non-invasive alternative. This study aimed to evaluate the diagnostic performance of LUS versus CXR in pediatric LRTIs, with a focus on subgroup variability.
methodsThis prospective observational study included 338 children (aged 1 month-18 years) with suspected LRTIs admitted to a tertiary care hospital. All patients underwent clinical assessment, CXR, and LUS at admission and follow-up. LUS findings were compared with CXR using sensitivity, specificity, predictive values, accuracy, and Cohen's kappa (κ) for agreement.
resultsLUS demonstrated high sensitivity for pulmonary pathology at admission (95.6%) and follow-up (96.7%), with specificity improving from 29.4% at admission to 62.9% at follow-up. Overall agreement between LUS and CXR progressed from fair at admission (Cohen's κ = 0.311, 95% CI: 0.198-0.424) to substantial at follow-up (Cohen's κ = 0.607, 95% CI: 0.501-0.713). Subgroup analysis demonstrated meaningful variation in LUS-CXR agreement across diagnostic categories. The highest concordance was observed in pneumonia (κ = 0.438-0.470, moderate agreement), consistent with LUS's established strength in detecting parenchymal consolidation. Agreement was notably lower in recurrent wheezing (κ = 0.208-0.283, fair agreement) and was poor to negligible in acute bronchiolitis (κ = -0.029-0.000) and the heterogeneous "others" group (κ = -0.053-0.182). LUS demonstrated high accuracy in detecting consolidations, subpleural lesions, and pleural abnormalities, and facilitated serial monitoring of disease progression during hospitalization.
conclusionLUS is a promising, radiation-free imaging modality for the diagnosis and follow-up of pediatric LRTIs, particularly pneumonia, demonstrating moderate to substantial agreement with CXR. Its lower specificity and reduced performance in airway-predominant conditions highlight the importance of cautious interpretation alongside clinical findings.
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