Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia

Farhan Pervaiz, Shakir Hossen, Miguel A. Chavez, Catherine H. Miele, Lawrence H. Moulton, Eric D. McCollum, Arun D. Roy, Nabidul H. Chowdhury, Salahuddin Ahmed, Nazma Begum, Abdul Quaiyum, Mathuram Santosham, Abdullah H. Baqui, William Checkley

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Pneumonia is a leading cause of death in children of low-resource settings. Barriers to care include an early and accurate diagnosis. Lung ultrasound is a novel tool for the identification of pediatric pneumonia; however, there is currently no standardized approach to train in image acquisition and interpretation of findings in epidemiological studies. We developed a training program for physicians with limited ultrasound experience on how to use ultrasound for the diagnosis of pediatric pneumonia and how to standardize image interpretation using a panel of readers. Methods: Twenty-five physicians participating in the training program conducted lung ultrasounds in all children with suspected pneumonia, aged 3 to 35 months, presenting to three subdistrict hospitals in Sylhet, Bangladesh, between June 2015 and September 2017. Results: A total of 9051 pediatric lung ultrasound assessments were conducted through 27 months of data collection. Study physicians underwent training and all were successfully standardized, achieving 91% agreement and maintained a sensitivity and specificity of 88% and 92%, respectively, when their diagnosis was compared with experts. Overall kappa between two readers was high (0.86, 95% confidence interval [CI], 0.84-0.87), and remained high when a third expert reader was included (0.80, 95% CI, 0.79-0.81). Agreement and kappa statistics were similarly high when stratified by age, sex, presence of danger signs, or hypoxemia. Conclusions: Lung ultrasound is a novel tool for the diagnosis of pediatric pneumonia with evidence supporting its validity and feasibility of implementation. Here we introduced a training program that resulted in a high level of inter-sonographer agreement.

Original languageEnglish (US)
Pages (from-to)1753-1759
Number of pages7
JournalPediatric pulmonology
Volume54
Issue number11
DOIs
StatePublished - Nov 1 2019

Keywords

  • pneumonia
  • standardization
  • training
  • ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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