As parents, teachers and other caregivers tackle flu season, RSV and Covid-19, cases of childhood pneumonia have also spiked in parts of the United States, China and Europe. Despite many advances in medicine, diagnosing pediatric pneumonia is still challenging, and the disease is often missed, regrettably leading to high mortality. According to the World Health Organization, pneumonia is the single largest infectious cause of death in children worldwide, and reports show that globally pneumonia is a leading cause of morbidity and mortality in children under the age of 5. In addition to diagnosis challenges and high mortality, traditional methods of for pediatric pneumonia can also be inexact and potentially harmful.
When a child is brought into a doctor’s office or ED with a potential case of pneumonia, providers first perform a physical examination, but the initial signs of pediatric pneumonia can be subtle, particularly in infants, and the common symptoms of the disease, such as cough, fever, chest pain, and shortness of breath, are often inconclusive – making the clinical examination unreliable. Still, providers are encouraged to avoid ordering a chest X-ray (the current gold standard diagnostic, albeit limited) and instead rely on their clinical judgement in all but the sickest pediatric patients, due to concern over radiation exposure.
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At the same time, pediatric care guidelines suggest providers avoid “just in case” antibiotics without an X-ray-confirmed diagnosis of pneumonia. Unfortunately, this prescription practice still occurs because the chest X-ray is an insensitive test, offering a limited ability to distinguish features of the disease. In turn, contributing to the antibiotic resistance challenge that has been growing in pediatric healthcare, especially for respiratory care.
So, what if there was a way to make better, safer and more informed care decisions? There is. Point-of-care lung ultrasound – also known as lung POCUS – is a safer, more reliable alternative that provides information quickly, yet it’s not widely considered the standard of care.
Lung POCUS can help make more accurate diagnoses immediately and at the bedside, minimizing exposure to harmful X-rays, limiting antibiotic use and shrinking the time to treatment decision down to minutes – instead of hours or even several days. Notably, use of X-ray and CT imaging has increased exponentially in the U.S. over the past 40 years, and if these trends continue, today’s children will have a significantly higher lifetime exposure to medical radiation than any other generation. While the risks of one X-ray seem small, it is critical to reduce X-ray exposure, especially for children, whenever possible.
Importantly, accessible diagnostic tools like POCUS have tremendous reassuring effects for the parents, which is needed in high-stress situations, like potential pneumonia diagnoses. Unlike a radiology or lab test, point-of-care lung ultrasound is performed at the bedside, by an attending physician as an extension of the physical exam, which can help ease parents’ concerns in real-time. Parents get to see the imaging happen and participate actively in their child’s care. Seeing a healthy lung at the bedside helps them to accept more conservative management choices versus them insisting on antibiotic therapy.
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Ultrasound technology has advanced exponentially over the past few years as handheld devices have become more accessible. Certain handheld ultrasound devices on the market today are capable of whole body imaging on a single probe and some even have presets dedicated to supporting accurate lung scanning. That said, as with many other innovations in clinical care, education is the biggest challenge to adoption. Many pediatricians continue to order chest X-rays because that is what they were taught to do in residency. Many might not even be aware that lung ultrasound is more accurate, and even if they do know, have not found the time or opportunity to learn this skill.
To meet the challenges and opportunities of the future, we must invest in educational resources that help pediatricians and other clinicians learn how to use this technology. Learning to confidently perform POCUS requires some upfront time commitment, but the long-term benefits are well worth it. For new learners, there are many educational resources available, and it is a matter of hours of training, not weeks or months. For those who are already comfortable doing other ultrasound exams, the scan protocols and clinical findings of lung ultrasound can be easily learned with little additional study. We are also seeing POCUS training rapidly expand into medical schools and residency programs, and a growing number of specialties are recognizing the benefits of POCUS and integrating it into the core skill expectations for that specialty.
POCUS is revolutionizing how we diagnose and treat life-threatening diseases, like childhood pneumonia. When armed with this technology, providers are making better and faster diagnoses and safer treatment decisions right at the bedside. Though change can often be slow in the world of healthcare, it’s critical that we advance education and training around the benefits and use of point-of-care ultrasound, so that we can deliver the best possible care.
Photo: Jose Luis Pelaez Inc, Getty Images
Stephen Erickson is a Family Medicine physician practicing in Port Townsend, WA. He is also an Assistant Clinical Instructor at the University of Washington School of Medicine. A graduate of the University of Minnesota school of Medicine, Dr Erickson is a recognized expert in Point of Care Ultrasound in Primary Care. He has been performing bedside ultrasound throughout his 25-year career, teaches POCUS in a variety of settings, and has been active in ongoing POCUS related research and advocacy efforts. He is a fellow of the American Academy of Family Physicians, a member of the American Institute for Ultrasound in Medicine, and is Registered in Musculoskeletal Sonography through the APCA.
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