THE PREDICTIVE VALUE OF LUNG ULTRASOUND SCORES IN DEVELOPING BRONCHOPULMONARY DYSPLASIA: A PROSPECTIVE MULTICENTER DIAGNOSTIC ACCURACY STUDY.
Different lung ultrasound (LUS) scanning protocols have been used and the results in terms of diagnostic accuracy are heterogeneous.What is the diagnostic accuracy of the LUS score to predict moderate-severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy?and methods: This was a multicenter prospective observational study in 6 centers. Two LUS aeration scores, one involving only anterolateral lung fields (LUS score-al) and the other adding the posterior fields (LUS score-p) were obtained at birth, 3rd day of life (DOL), 7th DOL, 14th DOL and 21st DOL. The diagnostic accuracy of both scores to predict ms-BPD was assessed at each time point.832 LUS exams in 298 infants were included. Both LUS score-p and LUS score-al showed a similar moderate diagnostic accuracy to predict msBPD at 3rd DOL (AUC 95%CI: 0.68-0.85 vs 95%CI 0.68-0.85, p=0.97); 7th DOL (AUC 95%CI 0.74-0.85 vs 95%CI 0.74-0.84, p=0.26); and 21st DOL (AUC 95%CI 0.72 – 0.86 vs. 95%CI 0.74 -0.88, p=0.17). The LUS score-p was slightly more accurate at 14th DOL (AUC 95%CI 0.69-0.83 vs. 95%C: 0.66-0.80, p=0.01). A cut-off of 8 points in the LUS score-al at 7th DOL provided a sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of 70%, 79%, 3.3 and 0.38 respectively to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared to a predictive model based on multiple clinical variables: AUC 95%CI 0.77-0.88 vs 95%CI 0.80-0.91, p=0.52.The LUS score is able to predict msBPD since the 3rd DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.
Authors: Almudena Alonso-Ojembarrena, Iker Serna-Guerediaga, Victoria Aldecoa-Bilbao, Rebeca Gregorio-Hernández, Paula Alonso-Quintela, Ana Concheiro-Guisán, Alicia Ramos-Rodríguez, Mónica de Las Heras-Martín, Lorena Rodeño-Fernández, Ignacio Oulego-Erroz