Study design
The study was performed in the pediatric emergency department of the
Dokuz Eylul University Faculty of Medicine. Previously healthy children
between 1 month and 18 years of age were included. Patients were
excluded if they had life-threatening diseases requiring immediate
intervention; chronic pulmonary, cardiac, or neuromuscular diseases;
diaphragmatic hernia; diaphragm paresis; chest wall abnormalities;
genetic disorders; or history of cardiac/thoracic operation or
prematurity (<34 gestational week). The patients who presented
to the pediatric emergency department with suspicious clinical symptoms,
physical examination findings, and infiltration on CXR (if performed)
were considered as having suspected pneumonia and all of them were
examined by LUS. If pneumonia was confirmed by LUS, then the patients
were enrolled in the study and DUS was performed. The Pediatric
Respiratory Severity Score (PRESS) was used to indicate the severity of
the disease. This scoring system comprises respiratory rate, wheezing,
use of accessory muscles, refusal to feed, and oxygen saturation
SpO2 of <95% in room air. Each parameter was
scored with 0 or 1 point and the total score was classified as mild
(0–1 points), moderate (2–3 points), or severe (4–5 points) ¹⁷. The
demographic, clinical, and laboratory data of the patients were recorded
together with LUS findings, DUS parameters, and PRESS scores by a
pediatric emergency fellow at admission. Vital findings were monitored
by a nurse and the patients were evaluated by a pediatric assistant and
a pediatric emergency fellow. Length of stay in the pediatric emergency
department, need for hospitalization, and length of total stay in the
hospital were recorded.