450 - Lung Ultrasound in the Evaluation of Asthma Exacerbation in Children and Adolescents.

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 450
Publication Number: 450.312

ROBERT M. HOFFMANN, BOSTON CHILDRENS HOSPITAL, BOSTON, MA, United States; Michelle Du, Boston Children's Hospital, Boston, MA, United States; Andrew F. Miller, Boston Children's Hospital, Boston, MA, United States; Jeffrey T. Neal, Boston Children's Hospital, Boston, MA, United States; Kyle A.. Nelson, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States; Michael Monuteaux, Boston Children's Hospital, Boston, MA, United States; Mark I. Neuman, Boston Children's Hospital, Boston, MA, United States; Cynthia A. Gravel, Boston Children's Hospital, Boston, MA, United States

Presenting Author(s)

Robert M. Hoffmann, MD (he/him/his)

Fellow
BOSTON CHILDRENS HOSPITAL
BOSTON, Massachusetts, United States

Background: Point-of-care Lung Ultrasound (LUS) has been studied for the evaluation of pneumonia in children, but limited data exists regarding lung ultrasound findings in children with asthma exacerbations.

Objective: The aim of the study was to characterize LUS findings in children with asthma exacerbations and to determine whether the presence and magnitude of findings were associated with asthma severity.

Design/Methods: We enrolled a convenience sample of patients aged 5-18 years presenting for evaluation and treatment of acute asthma exacerbation to a single tertiary care pediatric emergency department. All children had a Hospital Asthma Severity Score (HASS) score performed within 1-hour of performance of LUS. Severity of asthma exacerbation was classified with HASS scores as follows: mild: 0-6; moderate: 7-9; severe: 10-15. LUS were performed by trained pediatric emergency providers who were blinded to all clinical information. The presence of LUS findings (B-lines, consolidations [including those >1cm as well as < 1cm], pleural effusion and pleural line abnormalities) was assessed using a standardized data collection instrument. Differences in LUS findings across asthma exacerbation severity groups were evaluated using chi square tests.

Results: A total of 100 patients with a median age of 9.4 years (Interquartile range 6, 12) were enrolled. LUS was positive for any finding in 61% of patients. Pleural line irregularities were observed in 35%, B-line pattern in 29%, consolidations < 1cm in 25%, consolidations ≥ 1cm in 7 % and pleural effusions in 1%. Patients with a HASS score indicating severe asthma exacerbation were more likely to have B-lines (11/27,41%) than patients with mild exacerbations (4/30,13%; p=0.04).

Conclusion(s):

LUS findings are commonly observed in patients presenting with asthma exacerbations. The most common observed findings were pleural line irregularities and B-lines. B-lines were more frequent in patients with severe asthma exacerbations. These findings have important implications for the diagnostic use of LUS in children with acute asthma exacerbation.