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Lung Ultrasound Is Safe Substitute for Chest X-Ray in Pediatric Pneumonia

NEW YORK -- Substituting lung ultrasound for chest X-ray to diagnose pneumonia in children is both safe and feasible, according to a new study.

The article was published in the journal Chest. It notes that pneumonia is the top cause of death in children around the world, yet chest X-ray, generally the preferred test, is not available to three-quarters of the world’s population.

For the study, Icahn School of Medicine researchers conducted a randomized controlled trial in the pediatric emergency department at The Mount Sinai Hospital, comparing lung ultrasound to chest X-ray in 191 children from birth to age 21.

Patients were randomly assigned into an investigational arm — in which participants received a lung ultrasound and, if the physician needed additional verification, a chest X-ray — and a control arm — in which participants received a chest X-ray followed by a lung ultrasound.

Results indicate a 38.8% reduction in chest X-rays in the investigational arm compared to no reduction in the control arm. No pneumonia cases were missed, and the investigators identified no increase in any other adverse events.

"Ultrasound is portable, cost-saving, and safer for children than an X-ray because it does not expose them to radiation," said lead investigator James Tsung, MD, MPH. "Our study could have a profound impact in the developing world where access to radiography is limited."

The reduction in chest X-rays in the investigational arm resulted in an overall cost savings of $9,200, while decreasing ED length of stay by an average of 26 minutes.

"In the era of precision medicine, lung ultrasound may also be an ideal imaging option in children who are at higher risk for radiation-induced cancers or have received multiple radiographic or CT imaging studies," Tsung said in a Mount Sinai Health System press release.

The authors call for more research on how antibiotic use and stewardship are affected by lung ultrasound use.