Meta-analysis of Lung Ultrasound and Chest Radiography in the Diagnosis of Suspected Pulmonary Infections in Children

Background Pulmonary infectious diseases are a major cause of morbidity and mortality in pediatrics. Lung ultrasound (LUS) has emerged as a diagnostic tool with advantages such as low cost and the absence of radiation exposure. However, its diagnostic performance compared to conventional methods like chest radiography, or called chest X-ray (CXR), needs further evaluation. Methods A comprehensive study search was conducted based on the online databases including PubMed, EMBASE, Web of Science, ScienceDirect, Wiley Online Library, and Google Scholar. Studies evaluating and comparing the diagnostic performance of LUS and CXR for pulmonary infections in children were retrieved. Relevant data were extracted, and pooled effect sizes were synthesized to assess the diagnostic accuracy of LUS versus CXR in suspected pediatric pulmonary infections. Results A total of 655 relevant articles were initially retrieved, and after exclusion, 13 articles were included in the selection, with a total of 2260 pediatric patients involved. Among them, 11 research subjects were patients with common pneumonia, and 2 research subjects were patients with pulmonary tuberculosis. The pooled analysis showed that the sensitivity of LUS and CXR in diagnosing suspected pneumonia in children was 0.94, 95%CI [0.90, 0.97] and 0.86, 95%CI [0.80, 0.89], respectively, while the specificity was 0.77, 95%CI [0.65, 0.86] and 0.74, 95%CI [0.59, 0.85], respectively; the Positive Likelihood Ratio (PLR) of LUS and CXR was 4.16, 95%CI [2.58, 6.70] and 3.29, 95%CI [2.08, 5.23], respectively, and the Negative Likelihood Ratio (NLR) was 0.08, 95%CI [0.04, 0.13] and 0.19, 95%CI [0.14, 0.26]; the areas under the sensitivity receiver operating characteristic (SROC) curve of LUS and CXR were 0.95, 95%CI [0.92 - 0.96] and 0.88, 95%CI [0.85 - 0.91], respectively. In children with suspected pulmonary infections (including pneumonia and tuberculosis), no significant difference was observed in the detection rate of consolidations between LUS and CXR, risk difference (RD)=0.07, 95%CI [-0.09; 0.23], P=0.41; but the detection rate of pleural effusion by LUS was significantly higher than that by CXR, RD=0.06, 95%CI [0.01; 0.10], P=0.02. No significant difference was found in the detection rate of tuberculosis lymph adenopathy between LUS and CXR, RD=-0.09, 95%CI [-0.45; 0.27], P=0.55. Conclusion Lung ultrasound and chest X-ray showed comparable detection rates for pulmonary consolidation in children with suspected pulmonary infections. However, LUS was significantly more effective in detecting pleural effusion. Overall, LUS demonstrated higher sensitivity, specificity, and diagnostic accuracy than CXR in the evaluation of pediatric pneumonia.