Chest X-ray vs. Lung Ultrasound in Pediatric Acute Respiratory Failure: A Comparison

This study aimed to compare the effectiveness of chest X-ray (CXR) and lung ultrasound (LUS) in evaluating children with acute respiratory failure (ARF). CXR is traditionally used in diagnosing ARF, but LUS is gaining attention as a potential alternative. Conducted at the University of Wisconsin-Madison from December 2018 to February 2020, the study included children aged 37 weeks of corrected gestational age to 18 years who were admitted to the pediatric intensive care unit (PICU) with ARF. LUS and CXR were both performed within 6 hours of each other, and their agreement was assessed using Kappa statistics (k/kmax). The results showed fair agreement between the two imaging modalities, with an overall 58% agreement (k/kmax = 0.36). In specific patterns, the agreement was lower: normal findings showed only 57% agreement (k = 0.032), interstitial patterns had 47% agreement (k = 0.003), and consolidation patterns showed 65% agreement (k = 0.29). Notably, CXR detected more abnormalities than LUS in this cohort, highlighting its greater sensitivity in identifying a range of pulmonary issues. While LUS is valuable in real-time assessments and provides a non-invasive alternative, the study indicates that CXR remains more effective for detecting a broader array of abnormalities in children with ARF. Clinicians should therefore consider the benefits and limitations of both imaging techniques when diagnosing ARF. However, due to the small sample size, the study suggests that additional research is necessary to fully understand the role of LUS in pediatric ARF. Further studies could help refine guidelines on when to use LUS versus CXR based on clinical needs and available resources.