Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress

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Arquivos
art_GIORNO_Pointofcare_lung_ultrasound_score_for_predicting_escalated_care_2023.PDF (1.06 MB)
Citações na Scopus
2
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
W B SAUNDERS CO-ELSEVIER INC
Autores
FRAGA, Andrea M. A.
Citação
AMERICAN JOURNAL OF EMERGENCY MEDICINE, v.68, p.112-118, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Purpose: Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early rec-ognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. Methods: This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ul-trasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. Results: A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneu-monia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). Conclusion: An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
Palavras-chave
Respiratory distress, Lung ultrasound score, Children, Noninvasive ventilation, Mechanical ventilation, Point-of-care
URI
https://observatorio.fm.usp.br/handle/OPI/54239
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICr
Artigos e Materiais de Revistas Científicas - HU
Artigos e Materiais de Revistas Científicas - LIM/05
Artigos e Materiais de Revistas Científicas - ODS/03