• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2020.tde-30092021-115041
Document
Author
Full name
Marcela Preto Zamperlini
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Schvartsman, Claudio (President)
Helman, Ricardo
Rodrigues, Joaquim Carlos
Suzuki, Lisa
Title in Portuguese
Estudo comparativo sobre acurácia do ultrassom e radiografia de tórax para diagnóstico de síndrome torácica aguda em crianças com anemia falciforme
Keywords in Portuguese
anemia falciforme
doença falciforme
pneumonia
síndrome torácica aguda
ultrassom de pulmão
ultrassom point-of-care
Abstract in Portuguese
Objetivo: Investigar a acurácia diagnóstica do ultrassom (US) point-of-care de pulmão, realizado por emergencistas pediátricos treinados, para diagnóstico de Síndrome Torácica Aguda (STA) em crianças com anemia falciforme. Métodos: Este foi um estudo observacional prospectivo, realizado na unidade de pronto-atendimento de um hospital infantil urbano de cuidados terciários. Pacientes pediátricos com antecedente de anemia falciforme eram incluídos se fossem realizar raio-x de tórax (RXT) por suspeita de STA. O US point-of-care de pulmão foi realizado por médicos emergencistas pediátricos treinados e interpretado como positivo ou negativo para consolidação. O padrão de referência foi a interpretação do RXT pelo médico emergencista como positivo ou negativo para consolidação. Uma análise secundária foi realizada utilizando-se o diagnóstico final na alta como referência.Resultados: Quatro médicos emergencistas realizaram os estudos de US de pulmão. 79 pacientes foram incluídos. A média de idade foi de 8 anos (intervalo de 1 a 17 anos). Quatorze pacientes (18%) receberam diagnóstico de STA com base em um novo infiltrado no RXT e 30 pacientes tiveram um diagnóstico final de STA na alta. Comparando com a interpretação do RXT como referência, o US de pulmão, apresentou sensibilidade de 100% (95%IC 77% a 100%), especificidade de 68% (95%IC 56% a 79%), valor preditivo positivo de 40% (95%IC 24% a 56%) e valor preditivo negativo de 100% (95%IC 92% a 100%) para o diagnóstico de STA. A acurácia do US foi de 73% (95%IC 62% a 83%). Ao usar o diagnóstico na alta como desfecho, o US de pulmão teve uma sensibilidade significativamente maior (97% vs. 47% p < 0,0001) e menor especificidade (88% vs. 100% p = 0,031) em comparação ao RXT. O US de pulmão também apresentou valores preditivos positivos mais baixos (83% vs. 100%, p = 0,009) e negativos mais altos (98% vs. 75%, p < 0,0001) do que o RXT. A acurácia geral do US também foi significativamente maior que o RXT (91% vs. 80%, p < 0,0001). Conclusão: Os resultados do estudo sugerem que o US de pulmão pode ter um papel como modalidade de imagem de primeira linha em pacientes pediátricos falciformes com suspeita de STA.
Title in English
Is point-of-care lung ultrasound an alternative to chest-xray for diagnosing acute chest syndrome in pediatric sickle cell patients? A prospective study
Keywords in English
acute chest syndrome
lung ultrasound
pneumonia
point-of-care ultrasound
sickle cell disease
Abstract in English
Objective: We investigate the performance characteristics of point-of-care lung ultrasound (LUS) by pediatric emergency physicians sonographers in the diagnosis of Acute Chest Syndrome (ACS) in sickle cell children. Methods: This was a prospective, observational study conducted in a pediatric ED of an urban tertiary care childrens hospital. Sickle cell pediatric patients were enrolled if they were to undergo chest x-ray (CXR) for suspected ACS. Point-of-Care LUS by trained pediatric emergency physicians was performed and interpreted as either positive or negative for consolidation. The primary gold standard was the emergency physician interpretation of the CXR. A secondary analysis was performed using diagnosis at discharge as the endpoint diagnosis. Results: Four pediatric emergency physicians performed the LUS studies. 79 patients were enrolled. The median age was 8 years (range 1 to 17 years). Fourteen patients (18%) received a diagnosis of ACS based on a new infiltrate on CXR in the ED and 30 patients had a final diagnosis of ACS at discharge. Comparing to the CXR interpretation as gold standard, Point-of-Care LUS had a sensitivity of 100% (95% CI 77% to 100%), specificity of 68% (95% CI 56% to 79%), positive predictive value of 40% (95% CI 24% to 56%), and negative predictive value of 100% (95% CI 92% to 100%) for the diagnosis of ACS. Overall LUS accuracy was 73,42% (95% CI 62% to 83%). When using diagnosis at discharge as the endpoint, LUS had a significantly higher sensitivity (97% vs. 47% p < 0,0001) and lower specificity (88% vs. 100% p = 0,031) compared to CXR. LUS also had lower positive (83% v. 100%, p=0,009) and higher negative (98% v. 75%, p< 0,0001) predictive values than CXR. The overall POCUS accuracy was also significantly higher than CXR (91% vs. 80%, p< 0,0001). Conclusion: LUS may have a role as first line imaging in sickle cell pediatric patients with suspected ACS.
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2021-09-30
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2022. All rights reserved.