TY - JOUR
T1 - Feasibility of training clinical officers in point-of-care ultrasound for pediatric respiratory diseases in Aweil, South Sudan
AU - Nadimpalli, Adi
AU - Tsung, James W.
AU - Sanchez, Ramon
AU - Shah, Sachita
AU - Zelikova, Evgenia
AU - Umphrey, Lisa
AU - Hurtado, Northan
AU - Gonzalez, Alan
AU - Teicher, Carrie
N1 - Publisher Copyright:
© 2019 by The American Society of Tropical Medicine and Hygiene.
PY - 2019
Y1 - 2019
N2 - Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such asAweil,SouthSudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat childrenwith antibioticswho only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings.Our goalwas to examine the feasibility of training themid-level provider cadre clinical officers (COs) in a Médecins Sans Frontiéres project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) betweenCOs and experts for lung consolidationwith air bronchograms was 0.73 (0.63-0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74-0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.
AB - Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such asAweil,SouthSudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat childrenwith antibioticswho only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings.Our goalwas to examine the feasibility of training themid-level provider cadre clinical officers (COs) in a Médecins Sans Frontiéres project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) betweenCOs and experts for lung consolidationwith air bronchograms was 0.73 (0.63-0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74-0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.
UR - http://www.scopus.com/inward/record.url?scp=85071900144&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.18-0745
DO - 10.4269/ajtmh.18-0745
M3 - Article
C2 - 31287049
AN - SCOPUS:85071900144
SN - 0002-9637
VL - 101
SP - 689
EP - 695
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 3
ER -