Comparison of Chest Ultrasound to Chest Radiography in screening for Pediatric Tuberculosis

Abstract

Abstract Background There is a lack of robust data on the utility of chest ultrasound scans (CUS) for triage and screening for pediatric TB. Therefore, we set out to compare CUS findings to chest radiography (CXR), which is the recommended imaging modality in children with presumptive PTB.Methods Eighty children up to 14 years of age with presumptive TB had a CUS and CXR performed by two separate radiologists, who looked for the presence of consolidation, lymphadenopathy and pleural effusion on both modalities. These were compared using Fisher’s exact test for independence to determine whether there was a significant difference in the findings between the two modalities. Cohen's kappa coefficient was used to calculate the inter-reader agreement between CXR and CUS. The following interpretations of the results were used: less than zero, no agreement; 0 to 0.20 slight agreement, 0.21 to 0.40 fair agreement, 0.41 to 0.60 moderate agreement, 0.61 to 0.80, substantial agreement and 0.81 to 1, almost perfect agreement. STATA version 15 was used for analysis.Results The proportion of children with abnormal findings (consolidation, lymphadenopathy and pleural effusions) on CUS was 65% (52/80) and 81.3% (65/80) on CXR. 62.5% (33/52) of those with abnormal findings on CUS and 51.3% (33/65) on CXR were likely to have TB. The overall inter-reader agreement for these characteristics was moderate (κ-0.42).Conclusion CUS detected more abnormalities in children with suspected TB. Overall, the findings were comparable to those of CXR, except for lymphadenopathy. Ultrasound is a promising screening and triage tool for treating pediatric TB. However, there is a need to compare the CUS with the gold standard.