The Utility of Bedside Lung Ultrasound Findings in Bronchiolitis.

OBJECTIVES: Recent literature suggests that bedside lung ultrasound may have a role in the evaluation of infants with bronchiolitis. B lines, which are multiple and diffuse vertical artifacts spreading from the lung pleural interface to the edge of the ultrasound screen, have been associated with thickened interlobular septa, extravascular lung water, and diffuse parenchymal disease. The aims of this study were (1) to describe the prevalence of B lines in children younger than 24 months presenting to the emergency department with wheezing, (2) to determine the interrater reliability of lung ultrasound findings in this setting, and (3) to determine the association of B lines with atopy and other clinical findings.

METHODS: This was a pilot, prospective, observational study of a convenience sample of patients younger than 2 years presenting with wheezing to a large academic pediatric hospital emergency department. Investigators performed lung ultrasound examinations, and a second provider reviewed the ultrasound examinations to determine interrater reliability. We performed univariate analyses to test for associations between ultrasound findings and atopy, acute illness severity, age, and treatment response.

RESULTS: Studies were obtained on 29 patients (mean [SD] age, 291 [187] days; 62% male). Twenty-one patients (72%) had compact B lines. B lines were significantly associated with older age and an absence of atopic features. There was poor correlation of lung ultrasound examination interpretation among enrolling providers.

CONCLUSIONS: In this small sample of patients with bronchiolitis, B lines were associated with older age and an absence of atopic features. Lung ultrasound interpretation had poor interrater reliability.