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 Hale Moulton, Eric McCollum, Arun D. Roy, Nabidul H. Chowdhury, Salahuddin Ahmed, Nazma Begum, Abdul Quaiyum, Mathuram Santosham, Abdullah Baqui, William Checkley

Research output: Contribution to journalArticle

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)
JournalPediatric pulmonology
DOIs
StateAccepted/In press - Jan 1 2019

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General Practitioners
Pneumonia
Pediatrics
Lung
Physicians
Education
Confidence Intervals
Bangladesh
Epidemiologic Studies
Early Diagnosis
Cause of Death
Sensitivity and Specificity

Keywords

  • pneumonia
  • standardization
  • training
  • ultrasound

ASJC Scopus subject areas

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

Cite this

Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia. / Pervaiz, Farhan; Hossen, Shakir; Chavez, Miguel A.; Miele, Catherine H.; Moulton, Lawrence Hale; McCollum, Eric; Roy, Arun D.; Chowdhury, Nabidul H.; Ahmed, Salahuddin; Begum, Nazma; Quaiyum, Abdul; Santosham, Mathuram; Baqui, Abdullah; Checkley, William.

In: Pediatric pulmonology, 01.01.2019.

Research output: Contribution to journalArticle

Pervaiz, Farhan ; Hossen, Shakir ; Chavez, Miguel A. ; Miele, Catherine H. ; Moulton, Lawrence Hale ; McCollum, Eric ; Roy, Arun D. ; Chowdhury, Nabidul H. ; Ahmed, Salahuddin ; Begum, Nazma ; Quaiyum, Abdul ; Santosham, Mathuram ; Baqui, Abdullah ; Checkley, William. / Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia. In: Pediatric pulmonology. 2019.
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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.",
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AU - Pervaiz, Farhan

AU - Hossen, Shakir

AU - Chavez, Miguel A.

AU - Miele, Catherine H.

AU - Moulton, Lawrence Hale

AU - McCollum, Eric

AU - Roy, Arun D.

AU - Chowdhury, Nabidul H.

AU - Ahmed, Salahuddin

AU - Begum, Nazma

AU - Quaiyum, Abdul

AU - Santosham, Mathuram

AU - Baqui, Abdullah

AU - Checkley, William

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

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