Lung ultrasound in outpatient approach to children with suspected COVID 19.

Background: Children with COVID 19 infection (CV19) generally have a mild disease whose main symptoms are fever and cough. Dyspnoea and hypoxemia are rarely reported and few data are available on the frequency and extent of lung involvement in children with CV19. In addition, due to the limited availability of diagnostic tests in Italy during the pandemic period and the relative reliability of the test results, the diagnostic suspicion of CV19 infection in most of the children was difficult to confirm. The aim of this study is to evaluate if lung ultrasound (LUS) was able to highlight typical interstitial lung lesions in children with persistent cough and suspected CV19, providing corroborating evidence of CV19 infection.

Methods: We retrospectively analysed the data of 32 children who came consecutively to our outpatient observation in the period between March 1st and April 30th, 2020 because of the presence of persistent cough for at least 3 days and with suspected CV19. All the children undergone clinical examination, oximetry measurement and LUS.

Results: Twenty over thirty-two children had US lesions compatible with the presence of CV19, many of them without clinical signs of respiratory distress. LUS is much more sensitive than clinical examination to detect lung injury in children with suspected CV19.

Conclusion: In the absence of reliable, highly sensitive diagnostic tests or when nasal swab is unworkable or there are too many requests to be performed quickly due to the pandemic, LUS should be used in children with persistent cough for whom a CV19 is suspected because it can highlight undiagnosed interstitial lung lesions and reinforce the diagnostic suspicion of CV19 This approach can be very useful in outpatient settings and in areas with limited medical resources such as developing countries.