Evaluation of lung usg findings of patients diagnosed withacute bronchiolitis in the Pediatric Emergency

Gurbuzer, EI. Evaluation Of Lung Usg Findings Of Patients Diagnosed With Acute Bronchiolitis In The Pediatric Emergency Department Specialization Thesis in Pediatrics, Hacettepe University Faculty of Medicine, Ankara, 2024. Lung ultrasound is a non-invasive and radiation-free imaging technique that allows for rapid acquisition of high-resolution images using sound waves. This technique enables detailed evaluation of the lower respiratory tract diseases, airways, pleural surface, and lung tissue. It is noted in the literature that lung ultrasound, especially in children with acute bronchiolitis, can accurately detect pulmonary anomalies and serve as an effective tool in predicting the need for hospitalization in advance. This study aimed to evaluate lung ultrasound findings in patients presenting to the pediatric emergency department with a diagnosis of acute bronchiolitis. Patients aged two years and younger who presented to the Pediatric Emergency Department of Hacettepe University Ihsan Dogramaci Children's Hospital with a diagnosis of acute bronchiolitis and underwent lung ultrasound between February 1, 2023, and February 20, 2024, were included in the study. Lung ultrasounds of the patients were performed by two competent researchers within the hours designated by the responsible researchers. Patients evaluated at triage with suspected acute bronchiolitis were notified to the researchers performing ultrasound by the triage nurse and/or physician (EİG, BA). The diagnoses and treatments of the patients were planned by the physician who provided initial care in the pediatric emergency department in accordance with local protocols. No interventions were made regarding the patients' diagnoses and treatment plans during this process. A statistically significant difference was found in terms of median ultrasound scores according to hospitalization status (p=<0.001). The median ultrasound scores of patients followed up as outpatients were the lowest among the three groups, while they were the highest among those admitted to the ward. A statistically significant difference was found in terms of median ultrasound scores according to length of hospital stay (p=<0.001). There was a statistically significant difference in median ultrasound scores according to the need for respiratory support (p=<0.001). A significant but weak correlation was shown between ultrasound score and respiratory score (rho= 0.378; p<0.001). The presence of consolidation ≥1 cm in any area significantly affected hospitalization status (p=0.006). The presence of confluent B lines in any area had a significant effect on hospitalization status (p=<0.001). The presence of consolidation ≥1 cm or confluent B lines in any area was statistically significant in terms of hospitalization duration and need for respiratory support. The absence of consolidation <1 cm did not have a statistically significant effect on hospitalization status, duration, or need for respiratory support. There was a statistically significant difference in median ultrasound scores according to initial SpO2 status (p=0.034). It was found that the median scores obtained from the anterolateral area were higher in patients receiving oxygen support, and this difference was statistically significant (p=0.004). Our study demonstrates that a score based on lung ultrasound findings is a useful technique for clinicians to identify patients who may benefit from higher-level care facilities and initiation of respiratory support.