Effectiveness of Point-of-care Lung Ultrasound vs Chest X-ray for the Management of Childhood Lower Respiratory Infections in Low-resource Setting: Single Center, Pragmatic, Open-label, Randomized, Controlled, Non-inferiority Clinical Trial
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Lower Respiratory Infection
- Sponsor
- Nagasaki University
- Enrollment
- 616
- Locations
- 1
- Primary Endpoint
- Correct management plan at the baseline on the basis of clinical assessment and chest image findings
- Status
- Not Yet Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The goal of this clinical trial is to evaluate the effectiveness of point-of-care lung ultrasound versus chest X-ray for the management of childhood lower respiratory infections in a low-resource setting.
The main question it aims to answer is:
Is point-of-care lung ultrasound as effective as chest X-ray for the management of childhood LRIs in a low-resource setting?
Participants will be assigned to either a point-of-care lung ultrasound group (intervention) or a chest X-ray group (control), to compare the effect on overall case management and various clinical outcomes (time to symptom resolution, rate of antibiotic use, length of stay, treatment costs).
Detailed Description
Background: Lower respiratory infections (LRIs) are the leading causes of mortality in children of low-middle income countries (LMICs) including Nepal; pneumonia being the major killer in under-5 population. Often, the cause of mortality is the delay in diagnosis and treatment, particularly when clinical assessments do not hint toward a diagnosis. In resource-limited settings, routine availability of chest X-ray (CXR) service is a challenge, it can be hazardous to children due to exposure to ionizing radiation. The Point-Of-Care Lung UltraSound (POCLUS) could be an alternative solution for the diagnosis and management of LRIs. Studies have already shown that lung ultrasound has a higher sensitivity and specificity than CXR in diagnosing childhood LRIs, however, none of the studies have yet evaluated its role in overall case management. Methods: Prospective, single-center, pragmatic, open-label, randomized, controlled, non-inferiority clinical trial, which will be conducted in the outpatient and emergency departments of a pediatric hospital in Nepal. A total of 616 children with clinical suspicion of LRI and requiring chest imaging will be randomized at 1:1 allocation to the intervention (POCLUS) and control (CXR) arms. Pediatricians will be trained to perform lung ultrasonography in children. Outcomes: Primary outcome is the proportion of 'correctly (effectively) managed' cases. Secondary outcomes include the proportion of cases with 'change in diagnosis and management plan due to intervention', time to symptom resolution, rate of antibiotic use, length of stay, and in-hospital costs, compared between intervention and control groups.
Investigators
Suraj BHATTARAI
PhD Fellow
London School of Hygiene and Tropical Medicine
Eligibility Criteria
Inclusion Criteria
- •Children with a suspected lower respiratory infection (LRI) brought to the outpatient or emergency department,
- •Requiring chest image for evaluation at baseline.
Exclusion Criteria
- •Children already hospitalized, received antibiotics, or had chest imaging at the hospital;
- •Follow-up (treated within the past 4 weeks) or referred cases;
- •Critical patients requiring emergency life-saving support including oxygen;
- •Children with one or more danger signs (lethargy or loss of consciousness, convulsion, unable to eat or vomiting everything, cyanosis, excess irritability)
Outcomes
Primary Outcomes
Correct management plan at the baseline on the basis of clinical assessment and chest image findings
Time Frame: From the date of randomization until the final disposition of patient (i.e. discharge, refer), assessed up to 3 weeks. In case of non-hospitalized participants, outcomes evaluated during 2nd follow up (day 7-10 of enrollment), assessed up to 2 weeks.
Proportion of participants who are prescribed a correct management plan at the baseline on the basis of clinical assessment and chest image findings, either point-of-care lung ultrasound or chest X-ray
Secondary Outcomes
- Time to symptom/sign resolution(From the date of randomization until disposition (i.e. discharge, referral) or symptom resolution criteria is met, whichever is earlier, assessed up to 3 weeks.)
- In-hospital treatment costs(From the date of randomization until disposition (i.e. discharge, referral), assessed up to 3 weeks.)
- Length of stay at hospital(From the date of randomization until disposition (i.e. discharge, referral), assessed up to 3 weeks.)
- Change in diagnosis and management plan(From the date of randomization until Day3-5 of enrollment, assessed up to 1 week.)
- Rate of antibiotic use(From the date of randomization until disposition (i.e. discharge, referral), assessed up to 3 weeks.)