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Agreement Between the World Health Organization Algorithm and Lung Consolidation Identified Using Point-of-Care Ultrasound for the Diagnosis of Childhood Pneumonia by General Practitioners

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dc.contributor.author Chavez, M.A.
dc.contributor.author Naithani, N.
dc.contributor.author Gilman, R.H.
dc.contributor.author Tielsch, J.M.
dc.contributor.author Khatry, S.
dc.contributor.author Ellington, L.E.
dc.contributor.author Miranda, J.J.
dc.contributor.author Gurung, G.
dc.contributor.author Rodriguez, S.
dc.contributor.author Checkley, W.
dc.date.accessioned 2019-02-22T14:54:03Z
dc.date.available 2019-02-22T14:54:03Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/5614
dc.description.abstract Purpose: The World Health Organization (WHO) case management algorithm for acute lower respiratory infections has moderate sensitivity and poor specificity for the diagnosis of pneumonia. We sought to determine the feasibility of using point-of-care ultrasound in resource-limited settings to identify pneumonia by general health practitioners and to determine agreement between the WHO algorithm and lung consolidations identified by point-of-care ultrasound. Methods: An expert radiologist taught two general practitioners how to perform point-of-care ultrasound over a seven-day period. We then conducted a prospective study of children aged 2 months to 3 years in Peru and Nepal with and without respiratory symptoms, which were evaluated by point-of-care ultrasound to identify lung consolidation. Results: We enrolled 378 children: 127 were controls without respiratory symptoms, 82 had respiratory symptoms without clinical pneumonia, and 169 had clinical pneumonia by WHO criteria. Point-of-care ultrasound was performed in the community (n = 180), in outpatient offices (n = 95), in hospital wards (n = 19), and in Emergency Departments (n = 84). Average time to perform point-of-care ultrasound was 6.4 ± 2.2 min. Inter-observer agreement for point-of-care ultrasound interpretation between general practitioners was high (κ = 0.79, 95 % CI 0.73–0.81). The diagnosis of pneumonia using the WHO algorithm yielded a sensitivity of 69.6 % (95 % CI 55.7–80.8 %), specificity of 59.6 % (95 % CI 54.0–65.0 %), and positive and negative likelihood ratios of 1.73 (95 % CI 1.39–2.15) and 0.51 (95 % CI 0.30–0.76) when lung consolidation on point-of-care ultrasound was used as the reference. Conclusions: The WHO algorithm disagreed with point-of-care ultrasound findings in more than one-third of children and had an overall low performance when compared with point-of-care ultrasound to identify lung consolidation. A paired approach with point-of-care ultrasound may improve case management in resource-limited settings. en_US
dc.language.iso eng
dc.publisher Springer
dc.relation.ispartof urn:issn:1432-1750
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Peru en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Child, Preschool en_US
dc.subject Infant en_US
dc.subject Sensitivity and Specificity en_US
dc.subject Prospective Studies en_US
dc.subject Developing Countries en_US
dc.subject Pneumonia en_US
dc.subject pneumonia en_US
dc.subject developing country en_US
dc.subject human en_US
dc.subject female en_US
dc.subject male en_US
dc.subject Article en_US
dc.subject priority journal en_US
dc.subject major clinical study en_US
dc.subject algorithm en_US
dc.subject child en_US
dc.subject prospective study en_US
dc.subject sensitivity and specificity en_US
dc.subject preschool child en_US
dc.subject World Health Organization en_US
dc.subject Algorithms en_US
dc.subject Nepal en_US
dc.subject Point-of-Care Systems en_US
dc.subject infant en_US
dc.subject childhood disease en_US
dc.subject world health organization en_US
dc.subject point of care testing en_US
dc.subject echography en_US
dc.subject general practitioner en_US
dc.subject emergency ward en_US
dc.subject case management en_US
dc.subject hospital information system en_US
dc.subject Case management en_US
dc.subject general practice en_US
dc.subject General Practice en_US
dc.subject health practitioner en_US
dc.subject observer variation en_US
dc.subject Observer Variation en_US
dc.subject Point-of-care ultrasound en_US
dc.subject radiologist en_US
dc.subject WHO algorithm en_US
dc.title Agreement Between the World Health Organization Algorithm and Lung Consolidation Identified Using Point-of-Care Ultrasound for the Diagnosis of Childhood Pneumonia by General Practitioners en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1007/s00408-015-9730-x
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.07


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