Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department
Abstract Background Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Clinician diagnosis and management vary due to limited objective assessment tools. Point-of-care lung ultrasound (LUS) offers a promising diagnostic and prognostic tool in the emergency depa...
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2025-01-01
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| Series: | The Ultrasound Journal |
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| Online Access: | https://doi.org/10.1186/s13089-025-00410-y |
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| author | Jaron A. Smith Michael C. Cooper Kenneth Yen Joan Reisch Bethsabee S. Stone |
| author_facet | Jaron A. Smith Michael C. Cooper Kenneth Yen Joan Reisch Bethsabee S. Stone |
| author_sort | Jaron A. Smith |
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| description | Abstract Background Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Clinician diagnosis and management vary due to limited objective assessment tools. Point-of-care lung ultrasound (LUS) offers a promising diagnostic and prognostic tool in the emergency department (ED), however, the time to perform LUS is of concern in the emergency setting. Methods Infants ≤ 12 months diagnosed with AB in the emergency department were enrolled. Two LUS techniques were performed sequentially: a 12-segment “lawnmower” approach and a posterior paravertebral “waterfall” technique. LUS were scored (0–36 for lawnmower; 0–6 for waterfall). Respiratory support (RS) was categorized into three levels: no RS (room air), low RS (wall O2 or heated high flow nasal cannula < 1L/kg), and high RS (heated high flow nasal cannula ≥ 1L/kg or positive pressure). Clinical data, including RS at 12 and 24 h, maximum RS, disposition, and length of stay, were extracted via chart review and compared to mean LUS scores for each technique. Calculated areas under the curve (AUC) were compared using the Youden Index (J). Results 82 infants were enrolled. The mean waterfall scanning time was 1.65 min (SD 0.55) compared to the lawnmower’s 7.65 min (SD 1.45). The difference between mean LUS scores for the waterfall technique was statistically significant for all disposition comparisons and nearly all RS comparisons. While the lawnmower AUC was greater than the waterfall AUC for all RS and disposition comparisons, the Youden Index (J) was statistically significantly different for only two of the eight comparisons. Conclusion The posterior-only LUS technique is faster than the lawnmower technique, provides comparable information for disposition, and has a stronger association with LOS, but is less associated with RS. The waterfall technique may be a suitable alternative to more time-intensive, thorough techniques. |
| format | Article |
| id | doaj-art-5d005bcb2aac4ec3a716a773ca09528f |
| institution | Kabale University |
| issn | 2524-8987 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Ultrasound Journal |
| spelling | doaj-art-5d005bcb2aac4ec3a716a773ca09528f2025-01-19T12:14:42ZengSpringerOpenThe Ultrasound Journal2524-89872025-01-0117111110.1186/s13089-025-00410-yComparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency departmentJaron A. Smith0Michael C. Cooper1Kenneth Yen2Joan Reisch3Bethsabee S. Stone4Department of Emergency Medicine, Phoenix Children’s HospitalBaystate Medical Center, Department of Emergency Medicine, Division of Pediatric Emergency MedicineDepartment of Pediatrics, Division of Emergency Medicine, University of Texas Southwestern, Children’s Medical CenterSchool of Public Health, Division of Statistics, University of Texas SouthwesternDepartment of Pediatrics, Division of Emergency Medicine, University of Texas Southwestern, Children’s Medical CenterAbstract Background Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Clinician diagnosis and management vary due to limited objective assessment tools. Point-of-care lung ultrasound (LUS) offers a promising diagnostic and prognostic tool in the emergency department (ED), however, the time to perform LUS is of concern in the emergency setting. Methods Infants ≤ 12 months diagnosed with AB in the emergency department were enrolled. Two LUS techniques were performed sequentially: a 12-segment “lawnmower” approach and a posterior paravertebral “waterfall” technique. LUS were scored (0–36 for lawnmower; 0–6 for waterfall). Respiratory support (RS) was categorized into three levels: no RS (room air), low RS (wall O2 or heated high flow nasal cannula < 1L/kg), and high RS (heated high flow nasal cannula ≥ 1L/kg or positive pressure). Clinical data, including RS at 12 and 24 h, maximum RS, disposition, and length of stay, were extracted via chart review and compared to mean LUS scores for each technique. Calculated areas under the curve (AUC) were compared using the Youden Index (J). Results 82 infants were enrolled. The mean waterfall scanning time was 1.65 min (SD 0.55) compared to the lawnmower’s 7.65 min (SD 1.45). The difference between mean LUS scores for the waterfall technique was statistically significant for all disposition comparisons and nearly all RS comparisons. While the lawnmower AUC was greater than the waterfall AUC for all RS and disposition comparisons, the Youden Index (J) was statistically significantly different for only two of the eight comparisons. Conclusion The posterior-only LUS technique is faster than the lawnmower technique, provides comparable information for disposition, and has a stronger association with LOS, but is less associated with RS. The waterfall technique may be a suitable alternative to more time-intensive, thorough techniques.https://doi.org/10.1186/s13089-025-00410-yPediatricsEmergency medicineBronchiolitisLung ultrasoundPoint-of-care ultrasound |
| spellingShingle | Jaron A. Smith Michael C. Cooper Kenneth Yen Joan Reisch Bethsabee S. Stone Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department The Ultrasound Journal Pediatrics Emergency medicine Bronchiolitis Lung ultrasound Point-of-care ultrasound |
| title | Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department |
| title_full | Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department |
| title_fullStr | Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department |
| title_full_unstemmed | Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department |
| title_short | Comparison of two point-of-care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department |
| title_sort | comparison of two point of care lung ultrasound techniques and their associated outcomes for bronchiolitis in the pediatric emergency department |
| topic | Pediatrics Emergency medicine Bronchiolitis Lung ultrasound Point-of-care ultrasound |
| url | https://doi.org/10.1186/s13089-025-00410-y |
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