Diagnostic Accuracy of Point-of-Care Ultrasound Versus Conventional Radiography for Early Detection of Pediatric Pneumonia in Pakistan: A Hospital-Based Study

Abstract

Background:
Pneumonia remains a leading cause of morbidity and mortality among children under five, particularly in low- and middle-income countries. Conventional chest radiography, while widely used, has limitations including radiation exposure, delayed imaging, and restricted accessibility in resource-limited settings. Point-of-care ultrasound (POCUS) offers a portable, radiation-free, and real-time alternative for early pneumonia diagnosis in pediatric populations.

Objective:
To compare the diagnostic accuracy of point-of-care ultrasound with conventional chest radiography for early detection of pneumonia in children under five years in hospital settings across Pakistan.

Methods:
A multicenter, cross-sectional diagnostic accuracy study was conducted from March to October 2023 at tertiary care hospitals in Lahore, Karachi, and Peshawar. A total of 230 children aged 2 months to 5 years with suspected pneumonia were included. Each child underwent both POCUS and chest radiography within 24 hours of admission. Imaging was independently interpreted by blinded radiologists. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen’s Kappa coefficient (κ) were calculated using SPSS version 26.

Results:
POCUS demonstrated higher sensitivity (95.6%) and specificity (93.2%) than chest radiography (83.5% and 90.1%, respectively). The diagnostic accuracy of POCUS was 94.8% compared with 86.2% for CXR. Agreement with the reference diagnosis was excellent for POCUS (κ = 0.89) and good for CXR (κ = 0.74). POCUS detected more consolidations (142 vs. 135) and pleural effusions (18 vs. 10) than CXR, with a significantly shorter examination time (p < 0.001).

Conclusion:
Point-of-care ultrasound is a reliable, rapid, and radiation-free alternative to chest radiography for diagnosing pediatric pneumonia, with superior diagnostic accuracy and practicality for use in low-resource healthcare settings.

Keywords:
Accuracy, Chest Radiography, Children, Diagnostic Imaging, Pneumonia, Point-of-Care Systems, Ultrasound