Accuracy of lung ultrasound in diagnosing the etiology of respiratory symptoms in hospitalized children, a prospective cohort study

Lung ultrasound (LUS) is an emerging radiation-free diagnostic tool with significant promise for identifying the causes of respiratory symptoms in hospitalized children. We conducted a prospective cohort study of 65 pediatric patients (September 2022–January 2023) to evaluate the accuracy of LUS in determining the etiology of acute respiratory illness compared to an expert panel’s final clinical diagnosis, and secondarily to chest X-ray (CXR). LUS examinations were performed within 24 hours of admission by an investigator blinded to CXR results, and the final diagnoses were established by a committee blinded to LUS findings. LUS demonstrated high diagnostic accuracy, correctly identifying the respiratory illness etiology in 92.3% of cases, with near-perfect agreement (κ = 0.86) with the final diagnosis. Sensitivity and specificity were high across etiologies, including bacterial pneumonia, viral infections, and asthma exacerbations. LUS also outperformed CXR in determining the cause of illness. Integrating LUS findings with clinical and laboratory data allowed effective differentiation between bacterial and viral infections, highlighting LUS as a safer and more accurate alternative to CXR. Our findings support the integration of LUS into pediatric respiratory care and warrant further research to validate its utility on a larger scale.