Home⇛The PCMC Journal⇛vol. 20 no. 2 (2024)

Utility of the BLUE (Bedside lung ultrasound in emergency) protocol in acute undifferentiated dyspnea among pediatric patients

Christian Anne C. Dauz | Jenina Liza Danao | Joie Aseamie Flores | Cristan Q. Cabanilla | Michael D Cabato | Jacquelyn Olib-Velazquez

Discipline: medicine by specialism

 

Abstract:

OBJECTIVE: This cross-sectional study aimed to evaluate the effectiveness of the BLUE (Bedside lung ultrasound in emergency) protocol compared to clinicoradiologic diagnosis for promptly identifying acute undifferentiated dyspnea in pediatric patients. MATERIALS AND METHODS: Conducted at the emergency room of the Philippine Children's Medical Center from August 2022 to May 2023, the study involved performing the BLUE protocol within 2 hours of patient arrival. Chest radiography was also conducted, with images independently interpreted by a pediatric pulmonologist, emergency medicine specialist, and radiologist. The results were then compared to the clinicoradiologic findings. RESULTS: A total of 111 participants were included, with the majority being male (55.4%) and under 1 year old (48.2%). Pneumonia was the most observed diagnosis (88.2%), followed by asthma (7.2%). Utilizing the BLUE protocol, pneumonia was identified as the most prevalent diagnosis (81%), followed by pleural effusion (12.6%) and asthma (6%). The pulmonologist, emergency medicine specialist, and radiologist exhibited high sensitivity in diagnosing pneumonia (91.01%, 89.89%, 96.77% respectively) but low specificity (26%, 21%, 57.89%). Diagnosing pleural effusion and/or congestion showed high sensitivity (89%) and low specificity (21%) based on the pulmonologist's reading, low sensitivity (37%) and high specificity (99%) based on the emergency medicine specialist's reading, and 100% specificity based on the radiologist's reading. All readers demonstrated high specificity (95%, 93%, 93%) and low sensitivity (50%, 71%, 71%) in diagnosing asthma. The ultrasound readings between the readers exhibited a high concordance rate of 98%. CONCLUSION: The study findings show that the BLUE protocol has high sensitivity in diagnosing pneumonia and high specificity in diagnosing asthma. The high concordance rate among readers suggests consistent ultrasound findings. These results support the practical application of the BLUE protocol for promptly diagnosing acute undifferentiated dyspnea in pediatric patients within the emergency department.



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