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Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress.
Giorno, Eliana P C; Foronda, Flavia K; De Paulis, Milena; Bou Ghosn, Danielle S N; Couto, Thomaz B; Sa, Fernanda V M; Fraga, Andrea M A; Farhat, Sylvia C L; Preto-Zamperlini, Marcela; Schvartsman, Claudio.
Afiliação
  • Giorno EPC; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Emergency Department, Hospital das Clinicas, Faculty of Medical Sciences, State University of Campinas, Sao Paulo, Brazil. Electronic address: eliana.giorno@hc.fm.usp.br.
  • Foronda FK; Pediatric Intensive Care Unit, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Pediatric Intensive Care Unit, Hospital Sirio-Libanes, Sao Paulo, Brazil.
  • De Paulis M; Emergency Department, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
  • Bou Ghosn DSN; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
  • Couto TB; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
  • Sa FVM; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
  • Fraga AMA; Emergency Department, Hospital das Clinicas, Faculty of Medical Sciences, State University of Campinas, Sao Paulo, Brazil.
  • Farhat SCL; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
  • Preto-Zamperlini M; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
  • Schvartsman C; Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Am J Emerg Med ; 68: 112-118, 2023 06.
Article em En | MEDLINE | ID: mdl-36966586
PURPOSE: Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early recognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. METHODS: This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ultrasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. RESULTS: A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneumonia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). CONCLUSION: An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Insuficiência Respiratória / Ventilação não Invasiva Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Humans / Infant / Newborn País/Região como assunto: America do sul / Brasil Idioma: En Revista: Am J Emerg Med Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome do Desconforto Respiratório / Insuficiência Respiratória / Ventilação não Invasiva Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Child / Child, preschool / Humans / Infant / Newborn País/Região como assunto: America do sul / Brasil Idioma: En Revista: Am J Emerg Med Ano de publicação: 2023 Tipo de documento: Article País de publicação: Estados Unidos