Point-of-care ultrasound for tuberculosis diagnosis in children
Description of tuberculosis (TB)-focused point-of-care ultrasound (POCUS) findings for children with presumptive TB. Cross-sectional study (July 2019 to April 2020). Simão Mendes hospital in Bissau, a setting with high TB, HIV, and malnutrition burdens. Patients aged between 6 months and 15 years wi...
| Autores: | , , , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2023 |
| País: | España |
| Institución: | Universitat Autònoma de Barcelona |
| Repositorio: | Dipòsit Digital de Documents de la UAB |
| Idioma: | inglés |
| OAI Identifier: | oai:ddd.uab.cat:307675 |
| Acceso en línea: | https://ddd.uab.cat/record/307675 https://dx.doi.org/urn:doi:10.1136/bmjopen-2022-066937 |
| Access Level: | acceso abierto |
| Palabra clave: | Tuberculosis Paediatrics Ultrasound |
| Sumario: | Description of tuberculosis (TB)-focused point-of-care ultrasound (POCUS) findings for children with presumptive TB. Cross-sectional study (July 2019 to April 2020). Simão Mendes hospital in Bissau, a setting with high TB, HIV, and malnutrition burdens. Patients aged between 6 months and 15 years with presumptive TB. Participants underwent clinical, laboratory and unblinded clinician-performed POCUS assessments, to assess subpleural nodules (SUNs), lung consolidation, pleural and pericardial effusion, abdominal lymphadenopathy, focal splenic and hepatic lesions and ascites. Presence of any sign prompted a POCUS positive result. Ultrasound images and clips were evaluated by expert reviewers and, in case of discordance, by a second reviewer. Children were categorised as confirmed TB (microbiological diagnosis), unconfirmed TB (clinical diagnosis) or unlikely TB. Ultrasound findings were analysed per TB category and risk factor: HIV co-infection, malnutrition and age. A total of 139 children were enrolled, with 62 (45%) women and 55 (40%) aged <5 years; 83 (60%) and 59 (42%) were severely malnourished (SAM) and HIV-infected, respectively. TB confirmation occurred in 27 (19%); 62 (45%) had unconfirmed TB and 50 (36%) had unlikely TB. Children with TB were more likely to have POCUS-positive results (93%) compared with children with unlikely TB (34%). Common POCUS signs in patients with TB were: lung consolidation (57%), SUNs (55%) and pleural effusion (30%), and focal splenic lesions (28%). In children with confirmed TB, POCUS sensitivity was 85% (95% CI) (67.5% to 94.1%). In those with unlikely TB, specificity was 66% (95% CI 52.2% to 77.6%). Unlike HIV infection and age, SAM was associated with a higher POCUS-positivity. Cohen's kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9. We found a high prevalence of POCUS signs in children with TB compared with children with unlikely TB. POCUS-positivity was dependent on nutritional status but not on HIV status or age. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children. |
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