Feasibility of Training Clinical Officers in Point-of-Care Ultrasound for Pediatric Respiratory Diseases in Aweil, South Sudan

• Published in: The American journal of tropical medicine and hygiene 2019-01, Vol.101 (3), p.689-695
• Main Authors: Nadimpalli, Adi, Tsung, James W, Sanchez, Ramon, Shah, Sachita, Zelikova, Evgenia, Umphrey, Lisa, Hurtado, Northan, Gonzalez, Alan, Teicher, Carrie
• Format: Article
• Language: English
• Subjects: Algorithms; Child, Preschool; Feasibility Studies; Female; Health Personnel - education; Health Resources; Humans; Infant; Lung - diagnostic imaging; Male; Pediatrics; Pediatrics - education; Pediatrics - methods; Pneumonia; Pneumonia - diagnostic imaging; Point-of-Care Systems; Respiratory Tract Infections - diagnostic imaging; South Sudan; Ultrasonic imaging; Ultrasonography
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.18-0745

Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who 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 goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières 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) between COs and experts for lung consolidation with 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.