Point-of-care ultrasound for tuberculosis diagnosis in children : a Médecins Sans Frontières cross-sectional study in Guinea-Bissau
Moretó Planas, Laura (Universitat Autònoma de Barcelona)
Sagrado, María José (Médicos Sin Fronteras (Barcelona))
Mahajan, Raman (Médicos Sin Fronteras (Barcelona))
Gallo, Jonathan (Médicos Sin Fronteras (Barcelona))
Gonçalves, Ramiro (Médicos Sin Fronteras (Barcelona))
Nuozzi, Pablo (Médicos Sin Fronteras (Barcelona))
Rocaspana, Merce (Médicos Sin Fronteras (Barcelona))
Fonseca, Jamila Vieira (Simão Mendes Hospital (Bissau, Guinea-Bissau))
Medina, Candida (Ministry of Health (Bissau, Guinea-Bissau))
Camará, Miguel (National Tuberculosis Program (Bissau, Guinea-Bissau))
Nadimpalli, Adi (Médicos Sin Fronteras (Barcelona))
Alonso, Beatriz (Médicos Sin Fronteras (Barcelona))
Llosa, Augusto E (Médicos Sin Fronteras (Barcelona))
Heuvelings, Lotje
Burza, Sakib (Médicos Sin Fronteras (Barcelona))
Molina Romero, Israel (Hospital Universitari Vall d'Hebron)
Stratta, Erin (Médicos Sin Fronteras (Barcelona))
Bélard, Sabine (University of Tübingen)

Data:	2023
Resum:	Description of tuberculosis (TB)-focused point-of-care ultrasound (POCUS) findings for children with presumptive TB. Cross-sectional study (July 2019 to April 2020). Simão Mendes hospital in Bissau, a setting with high TB, HIV, and malnutrition burdens. Patients aged between 6 months and 15 years with presumptive TB. Participants underwent clinical, laboratory and unblinded clinician-performed POCUS assessments, to assess subpleural nodules (SUNs), lung consolidation, pleural and pericardial effusion, abdominal lymphadenopathy, focal splenic and hepatic lesions and ascites. Presence of any sign prompted a POCUS positive result. Ultrasound images and clips were evaluated by expert reviewers and, in case of discordance, by a second reviewer. Children were categorised as confirmed TB (microbiological diagnosis), unconfirmed TB (clinical diagnosis) or unlikely TB. Ultrasound findings were analysed per TB category and risk factor: HIV co-infection, malnutrition and age. A total of 139 children were enrolled, with 62 (45%) women and 55 (40%) aged <5 years; 83 (60%) and 59 (42%) were severely malnourished (SAM) and HIV-infected, respectively. TB confirmation occurred in 27 (19%); 62 (45%) had unconfirmed TB and 50 (36%) had unlikely TB. Children with TB were more likely to have POCUS-positive results (93%) compared with children with unlikely TB (34%). Common POCUS signs in patients with TB were: lung consolidation (57%), SUNs (55%) and pleural effusion (30%), and focal splenic lesions (28%). In children with confirmed TB, POCUS sensitivity was 85% (95% CI) (67. 5% to 94. 1%). In those with unlikely TB, specificity was 66% (95% CI 52. 2% to 77. 6%). Unlike HIV infection and age, SAM was associated with a higher POCUS-positivity. Cohen's kappa coefficient for concordance between field and expert reviewers ranged from 0. 6 to 0. 9. We found a high prevalence of POCUS signs in children with TB compared with children with unlikely TB. POCUS-positivity was dependent on nutritional status but not on HIV status or age. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Tuberculosis ; Paediatrics ; Ultrasound
Publicat a:	BMJ open, Vol. 13 (may 2023) , ISSN 2044-6055

DOI: 10.1136/bmjopen-2022-066937
PMID: 37208138

10 p, 402.7 KB

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