ORIGINAL ARTICLE Lung Ultrasound is Comparable with Chest Roentgenogram for Diagnosis of Community-Acquired Pneumonia in Hospitalised Children Krishna Kumar Yadav 1 & Shally Awasthi 1 & Anit Parihar 2 Received: 2 September 2016 /Accepted: 27 February 2017 # Dr. K C Chaudhuri Foundation 2017 Abstract Objective To evaluate the accuracy of lung ultrasound (LUS) in comparison to chest roentgenogram (CXR) in hospitalised children with community-acquired pneumonia (CAP). Methods This study was a hospital based prospective obser- vational study, conducted between January 2014 and December 2014. Hospitalised children aged 2 to 59 mo with community-acquired pneumonia were included in the study. The informed written consent was taken from parents (or legal guardian) before recruitment. Children with suspected or proven asthma, cystic fibrosis, congenital heart disease, im- munodeficiency, malignancy and hemodynamic unstability were excluded. CXR, posterio-anterior view, and LUS were done within 24 h of the hospitalisation. Results Of 176 consecutively hospitalised cases of CAP, 118 were recruited after screening (65, 55.1% boys; mean age in months ± SD, 26.22 ± 19.60). Abnormal CXR were found in 101 (85.6%) and abnormal LUS in 105 (89%) children. In radiologically proven CAP, LUS was positive in 99/ 101(98.01%) while among radiologically normal, LUS was abnormal in 6/17 (35.3%). LUS has high sensitivity (98.02%) and reasonable specificity (64.71%) for diagnosing radiologically proven CAP. In diagnosing the specific radio- logical type of CAP, there was very good concordance (Quadratic Weighted Cohen’ s Kappa =0.7) between CXR and LUS. Similarly, the authors also found excellent concordance between CXR and LUS (Linear Weighted Cohen’ s Kappa =0.9) for diagnosis of pleural effusion. Conclusions LUS can be considered to be used first before radiography in children with suspected CAP. This will reduce the exposure of radiation. Keywords Community-acquired pneumonia . Children . Under-five years . X-ray chest . Lung ultrasound Introduction Community-acquired pneumonia (CAP) is the major cause of under-five mortality in children. According to World Health Organization (WHO), CAP contributed almost one-sixth of under-five mortality [1]. Similarly, 5.9 million global deaths of children under-five years of age was reported in 2015 and of which 1.2 million (20%) occurred in India alone [2]. As per WHO and other recommendations [3, 4], diagnosis and classification of CAP is largely clinical and chest radiog- raphy is recommended in severe and complicated cases only. But for a definitive diagnosis, physicians are mostly dependent on x-ray chest (CXR). CXR has certain limitations including risks of radiation exposure [5], high inter-observer and intra- observer variations [6, 7] and little impact on clinical outcomes [8]. Children have a 3 to 5 times higher radiation-induced morbidity and mortality risk in comparison to adults [5, 9] and a single CXR exposes to 3 mrem [10]. Therefore, CXR is not advisable as a routine in children with suspected CAP. Lung was considered off limits for the ultrasound until a few years ago. Lung Ultrasound (LUS) is relatively a new diagnostic instrument of CAP. LUS is a relatively smaller device that makes point of care more feasible. LUS is easy, rapid, portable and repeatable. The non-ionizing property is especially important in children, who carry a higher risk of * Shally Awasthi shally07@gmail.com 1 Department of Pediatrics, King George’ s Medical University, Lucknow, Uttar Pradesh 226003, India 2 Department of Radiodiagnosis, King George’ s Medical University, Lucknow, Uttar Pradesh, India Indian J Pediatr DOI 10.1007/s12098-017-2333-1