Usefulness of early lung ultrasound in acute mild–moderate acute bronchiolitis. A pilot study

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Las barras indican la comparación por parejas (alta a domicilio vs. ingreso en planta e ingreso en planta vs. ingreso en UCIP) en el test de comparaciones múltiples. p = 0,001 (test de Kruskal-Wallis)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elia Zoido Garrote, Cristina García Aparicio, Constanza Camila Torrez Villarroel, Antonio Pedro Vega García, Manoel Muñiz Fontán, Ignacio Oulego Erroz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Elia" "apellidos" => "Zoido Garrote" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "García Aparicio" ] 2 => array:2 [ "nombre" => "Constanza" "apellidos" => "Camila Torrez Villarroel" ] 3 => array:2 [ "nombre" => "Antonio" "apellidos" => "Pedro Vega García" ] 4 => array:2 [ "nombre" => "Manoel" "apellidos" => "Muñiz Fontán" ] 5 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Oulego Erroz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287918301881" "doi" => "10.1016/j.anpede.2018.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918301881?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318301176?idApp=UINPBA00005H" "url" => "/16954033/0000009000000001/v1_201901020605/S1695403318301176/v1_201901020605/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S234128791830187X" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.02.010" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "2405" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2019;90:19-25" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1519 "formatos" => array:3 [ "EPUB" => 102 "HTML" => 1075 "PDF" => 342 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "An initiative to reduce the use of unnecessary medication in infants with bronchiolitis in primary care" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "19" "paginaFinal" => "25" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Una iniciativa para reducir el uso de medicación innecesaria en lactantes con bronquiolitis en atención primaria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marta Montejo Fernández, Iñaki Benito Manrique, Arantza Montiel Eguía, Javier Benito Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marta" "apellidos" => "Montejo Fernández" ] 1 => array:2 [ "nombre" => "Iñaki" "apellidos" => "Benito Manrique" ] 2 => array:2 [ "nombre" => "Arantza" "apellidos" => "Montiel Eguía" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Benito Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403318301188" "doi" => "10.1016/j.anpedi.2018.02.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403318301188?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791830187X?idApp=UINPBA00005H" "url" => "/23412879/0000009000000001/v1_201901020610/S234128791830187X/v1_201901020610/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287918300577" "issn" => "23412879" "doi" => "10.1016/j.anpede.2018.03.003" "estado" => "S300" "fechaPublicacion" => "2019-01-01" "aid" => "2399" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2019;90:3-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1906 "formatos" => array:3 [ "EPUB" => 166 "HTML" => 1312 "PDF" => 428 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? 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The bars indicate the comparison of subset pairs (discharge home vs admission to ward and admission to ward vs admission to PICU) in the multiple comparison analysis. P=.001 (Kruskal–Wallis test)." ] ] ] "textoCompleto" => "IntroductionAcute bronchiolitis (AB) is the most frequent reason for hospital admission in infants, constituting a significant health care and economic burden. Although in most cases AB has a benign course, a subset of cases progress to severe disease requiring admission to the paediatric intensive care unit (PICU) and respiratory support, which are associated with a considerable morbidity and mortality. It is often difficult to predict which patients will have this adverse progression, which results in the need for prolonged inpatient monitoring in certain at-risk groups. Clinical severity scales are widely used and can be helpful to make an objective and reproducible assessment of the course of the disease and the response to treatment. However, there is insufficient evidence of their usefulness in predicting the outcomes of mild-to-moderate AB.<a class="elsevierStyleCrossRefs" href="#bib0140">1–3</a> The availability of a point-of-care tool allowing us to predict which patients may have an unfavourable course would be very useful for the purpose of preventing adverse events, intensifying monitoring and optimising the use of resources (transfer to hospitals with a PICU, early initiation of respiratory support, etc.).Lung ultrasound allows the assessment of the extent of pleuropulmonary involvement at the bedside easily and readily and without adverse effects. It has been proven to be useful and in many instances superior to chest radiography in the diagnosis of transient tachypnoea of the newborn, acute respiratory distress syndrome (ARDS), pneumonia, pleural effusion and pneumothorax.<a class="elsevierStyleCrossRefs" href="#bib0155">4–11</a> Despite the extensive evidence gathered on other acute pulmonary diseases, few studies have assessed the usefulness of lung ultrasound in AB. Studies published to date agree that the extent of lung lesions is associated with the severity of AB.<a class="elsevierStyleCrossRefs" href="#bib0195">12–14</a> It would thus be sound to hypothesise that the extent of lung involvement could be a valuable predictor of the clinical course of AB, as is the case in other diseases such as ARDS, in which it is of proven utility in predicting mortality or response to treatments such as prone ventilation or recruitment maneouvres.<a class="elsevierStyleCrossRefs" href="#bib0210">15–20</a> However, no study to date has assessed the usefulness of early lung ultrasound in predicting the clinical course of AB.We had 2 main objectives in conducting this study: on the one hand, to analyse the association between lung ultrasound findings and severity in mild-to-moderate AB as assessed by 2 clinical severity scores used in our region, and on the other to analyse whether early lung ultrasound findings are associated with clinical outcomes in patients presenting to hospital with mild-to-moderate AB.Patients and methodsSampleWe conducted a prospective observational study between October 2016 and March 2017. We defined AB as an episode of respiratory distress characterised by manifestations of lower respiratory tract involvement (wheezing, rales) following an upper respiratory tract infection in infants aged less than 12 months, whether or not this was the first episode of the kind.<a class="elsevierStyleCrossRefs" href="#bib0140">1,2</a> We included patients aged less than 1 year with a clinical diagnosis of mild-to-moderate AB managed in our hospital as long as the lung ultrasound examination was performed by the researchers in the first 24h of care. We excluded patients that presented to the hospital with severe AB (Wood-Downes score modified by Ferrés [MWDF]>8 and Hospital Sant Joan de Déu score [HSJD]>10), patients admitted to the PICU in the first 24h of care, patients with a diagnosis of pneumonia based on sonographic findings, patients with haemodynamically significant congenital heart disease and patients born preterm with a history of bronchopulmonary dysplasia, whose ultrasound features are very similar to those of AB.MeasuresWe collected demographic and clinical data for each patient at the time of arrival to hospital. The clinical assessment of the patients included measurement of vital signs and oxygen saturation and calculation of 2 clinical severity scores commonly used in our region (MWDF and HSJD scores) by the physician in charge.<a class="elsevierStyleCrossRefs" href="#bib0240">21,22</a> We analysed the clinical outcomes of patients in the month that followed their visit to our hospital (return to emergency department, hospital admission or development of early complications) through the review of electronic health records and telephone calls. We followed up patients admitted to hospital until they were discharged, recording the treatments they received and their clinical outcomes. The primary endpoints were the need for PICU admission, use of invasive mechanical ventilation, length of stay and duration of oxygen therapy. The main criterion for PICU admission was the development of severe respiratory distress, diagnosed based on clinical severity scores. Other criteria used to determine transfer to the PICU were apnoeic episodes, significant hypoxaemia (need of supplemental oxygen at concentrations of more than 50% to achieve a saturation greater than 90%) or hypercapnia.Lung ultrasoundIn adherence with the protocol of the study, all participants underwent a lung ultrasound examination within 24h of arrival to the hospital.The examination was performed with a portable ultrasound machine (SonoSite M-Turbo, Fujifilm, Japan) and a 6–13MHz linear array probe in all patients. Two paediatrics resident physicians (observer A and observer B) with previous experience in lung ultrasound performed the lung ultrasound examinations and interpreted their findings. These resident physicians had performed more than 25 lung ultrasound examinations in their clinical practice (mainly for diagnosis of pneumonia and its complications). They received specific training for this study delivered in two 2-h-long theoretical/practical workshops that included a review and discussion of the sonographic features of AB and performance under supervision of at least 10 lung ultrasound examinations in patients with AB (which were not included in the study).<a class="elsevierStyleCrossRefs" href="#bib0250">23–25</a>The imaging protocol included the examination of 10 chest zones (5 per hemithorax), capturing a 10-s video clip of each zone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). All images were recorded digitally for later analysis. The images were analysed in random order, and the evaluators were blinded to the clinical data of the patient to ensure an objective and unbiased interpretation. Three different elements of lung involvement in AB were assessed in each zone: pleural line abnormalities (PAs), extent of alveolar interstitial syndrome (AIS) and presence of subpleural lung consolidations (SCs). Pleural line abnormalities were defined as pleural thickening or loss of lung sliding; and graded with a score of 0 points (absence of abnormalities) or 1 point (presence of abnormality) adding to a possible maximum of 10 points for all zones. Interstitial syndrome was graded with a score of 0 points (normal pattern with a predominance of A lines), 1 point (AIS with converging B lines, defined as 3 or more B lines or white lung, in 1 intercostal space) or 2 points (AIS with convergent B lines, defined as 3 or more B lines per intercostal space or white lung, in 2 adjacent intercostal spaces) with a possible maximum of 20 points. Subpleural consolidation was graded with a score of 0 points (absent), 1 point (consolidation<1cm), and 2 points (consolidation<1cm or multiple consolidations) with a possible maximum of 20 points. We calculated the total lung ultrasound score (LUS-Sc) adding the scores for each individual zone. Thus, the maximum possible total score was 50 points (range, 0–50) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Statistical analysisWe summarised the data using the median and interquartile range, and absolute frequencies and percentages. In a first analysis, we assessed the interrater reliability between the paediatricians trained to perform the lung ultrasound examinations and a paediatrician with more than 5 years’ experience in the technique. We analysed the agreement in the assessment of PAs, AIS and the presence and extent of SCs in thirty 10-s clips randomly chosen from all the ultrasound examinations of patients with AB. We used the Cohen kappa coefficient to measure agreement, and considered agreement substantial if kappa was greater than 0.8 and moderate if kappa was greater than 0.6, applying the thresholds proposed by Landi and Koch. We used the intraclass correlation coefficient to assess the degree of interrater agreement. We then analysed the association between the LUS-Sc (total score and PA, AIS and SC subscores) and the clinical parameters of AB severity using the Spearman correlation coefficient. Last of all, we used multivariate regression to assess for the presence of an independent association between the LUS-Sc and the need for admission to the PICU, the length of stay and the duration of oxygen therapy. We considered P-values of less than 0.05 statistically significant. We performed the statistical analysis with the software SPSS version 22.0.Ethical considerationsThe study protocol was evaluated and approved by the Clinical Research Ethics Committee, and the parents or legal guardians of participants provided their written informed consent to their participation in the study and the publication of its results.ResultsWe included 59 patients with mild-to-moderate AB with a median age of 90 days (IQR, 30–270) and a median weight of 6.1kg (IQR, 4.8–7.9). Forty-four patients required hospital admission for a median length of stay of 5 days (IQR, 3–7.5), and 37 (84%) required oxygen therapy for a median of 3 days (IQR, 2–6). The lung ultrasound examination was performed at the time of admission to the paediatric ward in 41 patients, and in the emergency department in 18. Four patients (6.7%) were admitted to the PICU, and none required invasive mechanical ventilation. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the characteristics of the patients, and Appendix B presents supplementary material.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The interrater agreement between the paediatricians that performed and interpreted the ultrasound examinations and a paediatrician experienced in lung ultrasound was substantial for the assessment of PAs (observer A kappa, 0.851; observer B kappa, 0.841) and of AIS (observer A kappa, 0.836; observer B kappa, 0.877) and moderate for the assessment of SCs (observer A kappa, 0.620; observer B kappa, 0.695). The interrater intraclass correlation coefficient (absolute agreement between individual measurements) for the total score in the LUS-Sc was 0.917 (95% CI, 0.854–0.956).The ultrasound examinations were performed a median of 3 days (IQR, 2–4) from the onset of symptoms of AB. None of the patients were receiving respiratory support before the examination (except for conventional support with supplemental oxygen delivered via nasal prongs). The lung zones affected most frequently were the posterior paravertebral and the linea scapularis zones (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The median score in the LUS-Sc was 8 points (IQR, 5–13) in the overall sample, 6 points (IQR, 2–8) in the subset of patients discharged home from the emergency department, 9 points (IQR, 5–13.7) in the subset admitted to the paediatric ward and 17 points (IQR, 14.5–18) in the subset admitted to the PICU (P<.001) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We also found statistically significant differences in the degree of AIS (discharge home, 0 [IQR, 0–2]; admission to ward, 4.5 [IQR, 3–6]; transfer to PICU, 5.5 [IQR, 5–6]; P<.001) and of SCs (discharge home, 0 [IQR, 0–2]; admission to ward, 2 [IQR, 0–3.7]; transfer to PICU, 5 [IQR, 4.2–5.7]; P=.004), but not in the severity of PAs. We did not find significant differences in severity between infants aged less than 3 months and older infants: MWDF score of 5 (IQR, 4–6) vs 4.5 (IQR, 4–7) (P=.459), and HSJD score of 6 (IQR, 4–7) vs 5.5 (IQR, 4–7) (P=.662). However, the LUS-Sc scores were higher in infants aged less than 3 months: 9 (IQR, 6–13) vs 7.5 (IQR, 2–13) (P=.069), with a higher AIS subscore (3 [IQR, 1–5] vs 1 [IQR, 0–4.5]; P=.127), and more SCs (4.5 [IQR, 3–6] vs 2 [IQR, 0–4]; P=.106), although these differences were not statistically significant.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>We found a statistically significant correlation between the LUS-Sc scores, especially the degree of AIS and SCs, and all clinical parameters except the respiratory rate (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The strongest correlations were between the total LUS-Sc score and the scores in the MWDF (Spearman rho, 0.504, P<.001) and the HSJD scales (Spearman rho, 0.518; P<.001). <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> presents the scatterplots for these correlations.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>For every 5-point increase in the LUS-Sc, there were increases in the probability of admission to the PICU (OR, 2.5 [95% CI, 1.1–5.9]; P=.035), in length of stay by 1.2 days (95% CI, 0.55–1.86; P<.001) and in duration of oxygen therapy by 0.87 days (95%CI, 0.26–1.48; P=.006). These associations remained significant after adjusting for sex, weight, age, duration of AB symptoms and the presence of risk factors for severe AB (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionIn this preliminary study, we found that lung ultrasound findings were correlated to symptom severity in mild-to-moderate AB and had a certain value in the prediction of the subsequent course of the disease. However, our findings could not prove that they added to the information provided by clinical severity scores for the purpose of anticipating an unfavourable progression.Very few studies have used lung ultrasound in the context of AB, despite it being a method widely used in the assessment of patients with acute pulmonary diseases such as pneumonia, pleural effusion or lung oedema, in which its diagnostic yield exceeds that of plain X-rays while avoiding exposure to ionising radiation.<a class="elsevierStyleCrossRefs" href="#bib0160">5–7,12</a>In 2011, in a study comparing ultrasound and X-ray findings in patients with AB, Caiulo et al. found that the extent of SCs and AIS was associated with disease severity, and that the number and grading of SCs paralleled the scores in the Downes scale.<a class="elsevierStyleCrossRef" href="#bib0195">12</a> In 2015, Basile et al. assessed the usefulness of ultrasound abnormalities in patients with AB, in terms of the presence and extent of SCs and the degree of AIS, for identification of patients requiring oxygen therapy.<a class="elsevierStyleCrossRef" href="#bib0200">13</a> Our results were consistent with those of these studies, and we have also found evidence that abnormal ultrasound features exhibit a similar linear correlation with 2 validated clinical severity scores.<a class="elsevierStyleCrossRef" href="#bib0265">26</a>We ought to mention that our study did not find a linear correlation between respiratory rate (which is widely considered a sensitive marker of respiratory involvement) and lung ultrasound findings. We do not have an obvious explanation for this result. It is possible that the greater variability and the lack of specificity of respiratory rate (due to its association with fever, nasal obstruction, agitation in the patient, etc.) combined with the small sample size contributed to this unexpected result.Ultrasound findings such as PAs, SCs or the presence of AIS are not specific for AB and overlap significantly with the findings in other diseases with diffuse interstitial involvement, such as bronchopulmonary dysplasia or ARDS.<a class="elsevierStyleCrossRefs" href="#bib0165">6,27</a> However, our study and others in the previous literature are a proof of concept and suggest that the degree of sonographic abnormality reflects the severity of the pathophysiological process underlying AB to some extent. We know that the most severe cases of AB are those with presentations similar to that of ARDS, with severe interstitial involvement and a decrease in lung compliance as opposed to a pattern of obstruction and air trapping. It is possible that the early detection of reduced aeration by lung ultrasound could be useful in predicting the course of disease. In our study, we observed that patients that ended up requiring admission to PICU had more extensive involvement in the early ultrasound examination compared to patients discharged home or admitted exclusively to the paediatric ward, and also found that ultrasound was of some value in identifying patients that eventually required longer lengths of stay and more days of oxygen therapy. However, our statistical models did not show that these associations remained significant after adjusting for the clinical severity scores. This is not sufficient reason to definitely rule out the use of ultrasound in AB, but should rather encourage further research on its potential role in this disease. For instance, we observed that in patients with a similar severity determined on the basis of clinical features, ultrasound revealed a greater compromise of lung aeration in infants aged less than 3 months compared to older infants, which could contribute to the more severe course of disease observed in the younger set, in whom alveolar and interstitial involvement may be more prevalent, contrary to the predominance of obstruction and air trapping in older infants.All current clinical practice guidelines agree that routine use of diagnostic tests is not recommended in AB.<a class="elsevierStyleCrossRefs" href="#bib0140">1,2</a> However, ultrasound examination could be useful in cases where despite performing the routine clinical assessment the need for inpatient observation remains unclear. Sonographic evidence of extensive involvement should alert us to the possibility of progression to severe disease. Thus, in our study, a LUS-Sc score of more than 13.5 points had a sensitivity of 100% and a specificity of 82% in predicting admission to the PICU.LimitationsThe findings of our study must be interpreted taking into account its limitations. The ultrasound examination was performed a median of 3 days after the onset of AB, and while this is the time when symptoms usually peak, it is possible that there were differences between patients in the degree of lung involvement and that the administration of aerosol therapy affected the sonographic findings. However, there is no evidence in the literature that bronchodilators modify the course of disease or the sonographic features of lung involvement in AB. Our study included few patients, who also had relatively low scores (median of 8 points) in an ultrasound-based scale with a maximum possible score of 50 points. This may have limited the power of our study to detect an independent association between ultrasound findings and course of disease, which in the epidemic season under study tended to be relatively benign (short lengths of stay and few admissions to the PICU).The ultrasound score used in our study assessed more zones per lung than previous studies, which may affect its reproducibility and applicability to clinical practice. Our data suggest that the assessment of the number and extent of SCs may be somewhat subjective, as the interrater agreement was only moderate. Also, it seems that the assessment of PAs adds little to the information provided by the assessment of SC and AIS, so in future studies it might be convenient to simplify the score by eliminating this dimension.In the future, as the availability of ultrasound equipment and the training of paediatricians in ultrasound grow, the use of this technique in the management of respiratory diseases may become routine. However, to reach the full potential of lung ultrasound, systematic and validated assessment protocols need to be developed. In our opinion, future studies should focus on detecting which findings are most useful in predicting the course of AB. This would require the inclusion of enough patients that progress to severe forms and need mechanical ventilation, so multicentre studies would be preferable to ensure adequate recruitment.ConclusionsWe found a moderate correlation between the clinical severity scores and the degree of lung involvement evinced by early ultrasound examination in infants with mild-to-moderate AB. The most useful sonographic findings were those concerning the degree of AIS and SC. Lung ultrasound findings may be associated with clinical course and be useful to identify patients at risk of progression to severe disease.FundingXIX Clinical and Epidemiological Research Grant Competition—2016, Fundación Ernesto Sánchez Villares, Sociedad de Pediatría de Asturias, Cantabria y Castilla y León. Project 02/2016: Utilidad de la ecografía pulmonar en la valoración de la gravedad y pronóstico de la bronquiolitis aguda. Principal investigator: Elia Zoido Garrote. Grant of 3000 euro.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1132477" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1065080" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1132478" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1065079" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Measures" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Lung ultrasound" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Ethical considerations" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Discussion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Limitations" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-10-11" "fechaAceptado" => "2018-03-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1065080" "palabras" => array:6 [ 0 => "Bronchiolitis" 1 => "Ultrasound" 2 => "Oxygenoterapy" 3 => "Pilot study" 4 => "Score" 5 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1065079" "palabras" => array:6 [ 0 => "Bronquiolitis" 1 => "Ecografía" 2 => "Oxigenoterapia" 3 => "Estudio piloto" 4 => "Escala" 5 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine the correlation between the findings seen in early lung ultrasound with the clinical severity scales, and its association with the subsequent progression of the mild–moderate acute bronchiolitis (AB). Patients and methodsAn observational prospective study conducted on infants with mild–moderate AB, using lung ultrasound in the first 24h of hospital care. The lung involvement was graded (range 0–50 points) based on an ultrasound score (ScECO) and 2 routinely used clinical scales: the modified Wood Downes Ferres (WDFM), and the Hospital Sant Joan de Deu (HSJD). The relationship between the ScECO and the subsequent clinical progression (admission to the Paediatric Intensive Care Unit (PICU), days in hospital, and days of oxygen therapy) was also determined. ResultsThe study included a total of 59 patients, with a median age of 90 days (IQR: 30–270 days). The median ScECO score was 6 points (2–8) in the patients that did not require hospital admission, with 9 points (5–13.7) admitted to the ward, and 17 (14.5–18) in the patients who needed to be transferred from the ward to the PICU (P=.001). The ScECO had a moderate lineal association with the WDFM scale (rho=0.504, P<.001) and the HSJD (rho=0.518; P<.001). The ScECO was associated with admission to PICU [OR 2.5 (95% CI: 1.1–5.9); P=.035], longer hospital stay [1.2 days (95% CI: 0.55–1.86); P=.001] and duration of oxygen therapy [0.87 days (95% CI: 0.26–1.48); P=.006]. ConclusionsThere is a moderate correlation between early lung ultrasound findings with the severity of the AB evaluated by the clinical scales, as well as some relationship with the clinical progression." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar la correlación entre hallazgos de la ecografía pulmonar realizada precozmente con las escalas de gravedad clínica y su asociación con la evolución posterior en la bronquiolitis aguda (BA) leve-moderada. Pacientes y métodosEstudio observacional prospectivo. Se incluyó a lactantes con BA leve-moderada evaluados mediante ecografía pulmonar en las primeras 24 h tras la atención hospitalaria. Se graduó la afectación pulmonar (rango 0-50 puntos) sobre la base de un score ecográfico (ScECO). Se evaluó la correlación entre el ScECO y 2 escalas clínicas de uso habitual: escala de Wood Downes Ferres modificada (WDFM) y escala del Hospital Sant Joan de Déu (HSJD). Así mismo se valoró la asociación entre el ScECO y la evolución clínica posterior (ingreso en la Unidad de Cuidados Intensivos Pediátricos [UCIP], días de hospitalización y días de oxigenoterapia). ResultadosSe incluyó a 59 pacientes con una edad mediana de 90 días (RIQ: 30-270 días). La puntuación mediana del ScECO fue de 6 puntos (2-8) en los pacientes que no requirieron ingreso, 9 (5-13,7) en los ingresados en planta y 17 (14,5-18) en los pacientes que precisaron traslado de planta a la UCIP (p=0,001). El ScECO tuvo una correlación lineal moderada con la escala de WDFM (rho=0,504, p<0,001) y HSJD (rho=0,518; p <0,001). El ScECO se asoció al ingreso en UCIP (OR 2,5 [IC del 95%: 1,1-5,9]; p=0,035), mayor estancia hospitalaria (1,2 días [IC del 95%: 0,55, 1,86]; p=0,001) y duración de oxigenoterapia (0,87 días [IC del 95%: 0,26, 1,48]; p=0,006). ConclusionesLa ecografía pulmonar precoz se correlaciona de forma moderada con la gravedad de la BA evaluada por escalas clínicas y guarda cierta relación con la evolución clínica." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Zoido Garrote E, García Aparicio C, Camila Torrez Villarroel C, Pedro Vega García A, Muñiz Fontán M, Oulego Erroz I. Utilidad de la ecografía pulmonar precoz en bronquiolitis aguda leve-moderada: estudio piloto. An Pediatr (Barc). 2019;90:10–18." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0075" ] ] ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3433 "Ancho" => 2500 "Tamanyo" => 519539 ] ] "descripcion" => array:1 [ "en" => "(a) Protocol for lung ultrasound acquisition and interpretation. The scanned zones are marked with numbers. The ultrasound score is noted in the images labelled with letters. The images show the score assigned to each detected abnormality. (b) Normal lung: 0 points. (c) Pleural thickening. LUS-Sc: 1 point. (d) Focal AIS focal. LUS-Sc: 1 point. (e) Diffuse AIS. LUS-Sc: 2 points. (f) SCs<1cm. LUS-Sc: 1 point. (g) SCs>1cm. LUS-Sc: 2 points. AIS, alveolar interstitial syndrome; SC, subpleural consolidation; 1: anterior parasternal zone; 2: anterior axillary zone; 3: posterior axillary zone; 4 posterior paravertebral zone; 5: posterior linea scapularis zone." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1288 "Ancho" => 1600 "Tamanyo" => 75468 ] ] "descripcion" => array:1 [ "en" => "Boxplots of the distribution of the values of the lung ultrasound score by course of disease category. The bars indicate the comparison of subset pairs (discharge home vs admission to ward and admission to ward vs admission to PICU) in the multiple comparison analysis. P=.001 (Kruskal–Wallis test)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1175 "Ancho" => 2962 "Tamanyo" => 98238 ] ] "descripcion" => array:1 [ "en" => "Scatterplots showing the correlation between the LUS-Sc and the clinical severity scores." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Risk factors for AB: age<6 weeks, preterm birth<35 weeks’ gestation, chronic cardiac or respiratory disease, immunodeficiency and absence of exclusive breastfeeding.HS, hypertonic saline." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Characteristics of Acute Bronchiolitis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (62.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (30–270) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.1 (4.8–7.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (56–68) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Risk factors for AB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (49.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2–4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Severity of AB</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MWDF score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">a. Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (20.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">b. Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (79.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HSJD score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (4–7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">a. Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (42.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">b. Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (57.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hospitalisation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (74%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Inpatient treatment</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">a. Oxygen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (84%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">b. HS 3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (31.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">c. Bronchodilators \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">d. Bronchodilators+HS 3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (59%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">d. Systemic corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">e. Antibiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">f. Intravenous fluid therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (13.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Outcomes</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of oxygen therapy (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (2–6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of stay (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3–7.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Admission to PICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Invasive mechanical ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lung ultrasound (total score) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5–13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pleural line abnormalities (0–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3–6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Interstitial syndrome (0–20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Subpleural consolidations (0–20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932336.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Patient characteristics." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "AIS, alveolar interstitial syndrome; PA, pleural line abnormality; SC, subpleural consolidation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Lung zone</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anterior parasternal \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anterior axillary \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Posterior axillary \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Posterior paravertebral \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Posterior linea scapularis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SCs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932332.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Relative frequency of lung involvement detected by ultrasound in the assessed lung zones (the mean of both lungs is showed for each zone)." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "HR, heart rate; HSJD, Hospital Sant Joan de Déu score; MWDF, Wood Downes score modified by Ferrés; RR, respiratory rate; SatO2, oxygen saturation." "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SatO2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MWDF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HSJD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">LUS-Sc \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.092 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.366<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.296<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.504<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.518<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pleural line abnormalities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.060 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3343<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.097 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.383<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.355<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Alveolar interstitial syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.268<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.327<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.458<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.484<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Subpleural consolidations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.403<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.303<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.463<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.502<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932337.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SatO2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MWDF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HSJD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="6" align="left" valign="top">LUS-Sc</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><8 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (42–62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">143 (130–160) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (94–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥8 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (44–60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160 (144–172)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (90–98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–6)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5–8)<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932334.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "P<.05." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "P<.01." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "***" "nota" => "P<.001." ] ] ] "descripcion" => array:1 [ "en" => "Spearman correlation coefficients for the association of lung ultrasound findings and clinical parameters. Value of the clinical parameters relative to the median lung ultrasound score." ] ] 6 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "We assessed the association between the ultrasound score and admission to the PICU by logistic regression, and the association of the ultrasound score and the length of stay and the duration of oxygen therapy with linear regression. We present the ORs and B coefficients for 5-point increases in the ultrasound score with the corresponding 95% confidence intervals and P-values. The model was adjusted for sex, weight, age, duration of AB and presence of risk factors for severe AB (age<6 weeks, preterm birth<35 weeks’ gestation, underlying chronic disease or absence of exclusive breastfeeding)." "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PICU admission</th></tr><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2.5 (1.1–5.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.035 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.75 (1.12–12.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932333.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Length of stay (days)</th></tr><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B coefficient (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B coefficient (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1.2 (0.55. 1.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.09 (0.29–1.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932338.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Days of oxygen therapy</th></tr><tr title="table-row"><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Univariate</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B coefficient (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B coefficient (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0.87 (0.26–1.48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.75 (0.10–1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932335.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association between the total lung ultrasound score and clinical endpoints in the multivariate analysis." ] ] 7 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 22961 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "208.e1–208.e10" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Simó Nebot" 1 => "G. Claret Teruel" 2 => "C. Luaces Cubells" 3 => "M.D. Estrada Sabadell" 4 => "J. Pou Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2010" "volumen" => "73" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.L. Ralston" 1 => "A.S. Lieberthal" 2 => "H.C. Meissner" 3 => "B.K. Alverson" 4 => "J.E. Baley" 5 => "A.M. Gadomski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2014-2742" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2014" "volumen" => "134" "paginaInicial" => "e1474" "paginaFinal" => "e1502" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25349312" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Conferencia de consenso sobre bronquiolitis aguda (iii): diagnóstico en la bronquiolitis aguda. Revisión de la evidencia científica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Ochoa Sangrador" 1 => "J. González de Dios" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2010" "volumen" => "72" "paginaInicial" => "284.e1" "paginaFinal" => "284.e23" "itemHostRev" => array:3 [ "pii" => "S0091674917310849" "estado" => "S300" "issn" => "00916749" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound diagnosis of pneumonia in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Copetti" 1 => "L. Cattarossi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11547-008-0247-8" "Revista" => array:6 [ "tituloSerie" => "Radiol Med" "fecha" => "2008" "volumen" => "113" "paginaInicial" => "190" "paginaFinal" => "198" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18386121" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Reali" 1 => "G.F.S. Papa" 2 => "P. Carlucci" 3 => "P. Fracasso" 4 => "F.D. Marco" 5 => "M. Mandelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000362692" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2014" "volumen" => "88" "paginaInicial" => "112" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24992951" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound: its role in neonatology and pediatrics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Cattarossi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0378-3782(13)70006-9" "Revista" => array:6 [ "tituloSerie" => "Early Hum Dev" "fecha" => "2013" "volumen" => "89" "paginaInicial" => "S17" "paginaFinal" => "S19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23809341" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential of ultrasound in the pediatric chest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Trinavarat" 1 => "M. Riccabona" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2014.04.011" "Revista" => array:7 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2014" "volumen" => "83" "paginaInicial" => "1507" "paginaFinal" => "1518" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24844730" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0953620515001429" "estado" => "S300" "issn" => "09536205" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound in the critically ill (LUCI) and the lung point: a sign specific to pneumothorax which cannot be mimicked" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Moreno-Aguilar" 1 => "D. Lichtenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-015-1030-6" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2015" "volumen" => "19" "paginaInicial" => "311" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26345706" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Application of lung ultrasonography in the diagnosis of childhood lung diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.W. Chen" 1 => "M.Y. Zhang" 2 => "J. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chin Med J (Engl)" "fecha" => "2015" "volumen" => "128" "paginaInicial" => "2672" "paginaFinal" => "2678" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound in the diagnosis and monitoring of community acquired pneumonia in children" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Urbankowska" 1 => "K. Krenke" 2 => "Ł. Drobczyński" 3 => "P. Korczynski" 4 => "T. Urbankowski" 5 => "M. Krawiec" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2015.06.011" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2015" "volumen" => "109" "paginaInicial" => "1207" "paginaFinal" => "1212" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26138897" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Pereda" 1 => "M.A. Chavez" 2 => "C.C. Hooper-Miele" 3 => "R.H. Gilman" 4 => "M.C. Steinhoff" 5 => "L.E. Ellington" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2014-2833" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2015" "volumen" => "135" "paginaInicial" => "714" "paginaFinal" => "722" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25780071" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound in bronchiolitis: comparison with chest X-ray" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.A. Caiulo" 1 => "L. Gargani" 2 => "S. Caiulo" 3 => "A. Fisicaro" 4 => "F. Moramarco" 5 => "G. Latini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00431-011-1461-2" "Revista" => array:5 [ "tituloSerie" => "Eur J Pediatr" "fecha" => "2011" "volumen" => "170" "paginaInicial" => "1427" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21468639" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Basile" 1 => "A. di Mauro" 2 => "E. Scalini" 3 => "P. Comes" 4 => "I. Lofù" 5 => "M. Mostert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Pediatrics" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "63" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of bedside lung ultrasound findings in bronchiolitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.S. Cohen" 1 => "N. Hughes" 2 => "S. Tat" 3 => "J.M. Chamberlain" 4 => "S.J. Teach" 5 => "K. Boniface" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PEC.0000000000000820" "Revista" => array:6 [ "tituloSerie" => "Pediatr Emerg Care" "fecha" => "2017" "volumen" => "33" "paginaInicial" => "97" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27668919" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Bouhemad" 1 => "H. Brisson" 2 => "M. le-Guen" 3 => "C. Arbelot" 4 => "Q. Lu" 5 => "J.-J. Rouby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201003-0369OC" "Revista" => array:7 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2011" "volumen" => "183" "paginaInicial" => "341" "paginaFinal" => "347" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20851923" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0168822714001715" "estado" => "S300" "issn" => "01688227" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound can be used to predict the potential of prone positioning and assess prognosis in patients with acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "X. Wang" 1 => "X. Ding" 2 => "H. Zhang" 3 => "H. Chen" 4 => "L. Su" 5 => "D. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-016-1558-0" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2016" "volumen" => "20" "paginaInicial" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27899151" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0167527316310853" "estado" => "S300" "issn" => "01675273" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Zhao" 1 => "L. Jiang" 2 => "X. Xi" 3 => "Q. Jiang" 4 => "B. Zhu" 5 => "M. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMC Pulmon Med" "fecha" => "2015" "volumen" => "15" "paginaInicial" => "98" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of lung ultrasound in detection of complications of respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H.K. Sawires" 1 => "E.A. Abdel Ghany" 2 => "N.F. Hussein" 3 => "H.M. Seif" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ultrasmedbio.2015.04.024" "Revista" => array:6 [ "tituloSerie" => "Ultrasound Med Biol" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "2319" "paginaFinal" => "2325" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26027895" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound assessment of antibiotic-induced pulmonary reaeration in ventilator-associated pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Bouhemad" 1 => "Z.H. Liu" 2 => "C. Arbelot" 3 => "M. Zhang" 4 => "F. Ferarri" 5 => "M. 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Original Article

Usefulness of early lung ultrasound in acute mild–moderate acute bronchiolitis. A pilot study

Utilidad de la ecografía pulmonar precoz en bronquiolitis aguda leve-moderada: estudio piloto

Elia Zoido Garrotea,

Corresponding author

eliazoido@gmail.com

Corresponding author.

, Cristina García Aparicioa, Constanza Camila Torrez Villarroelb, Antonio Pedro Vega Garcíab, Manoel Muñiz Fontána, Ignacio Oulego Erroza

a Servicio de Pediatría, Hospital de León, León, Spain

b Servicio de Radiodiagnóstico, Hospital de León, León, Spain

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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Boxplots of the distribution of the values of the lung ultrasound score by course of disease category&#46; The bars indicate the comparison of subset pairs &#40;discharge home vs admission to ward and admission to ward vs admission to PICU&#41; in the multiple comparison analysis&#46; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001 &#40;Kruskal&#8211;Wallis test&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute bronchiolitis &#40;AB&#41; is the most frequent reason for hospital admission in infants&#44; constituting a significant health care and economic burden&#46; Although in most cases AB has a benign course&#44; a subset of cases progress to severe disease requiring admission to the paediatric intensive care unit &#40;PICU&#41; and respiratory support&#44; which are associated with a considerable morbidity and mortality&#46; It is often difficult to predict which patients will have this adverse progression&#44; which results in the need for prolonged inpatient monitoring in certain at-risk groups&#46; Clinical severity scales are widely used and can be helpful to make an objective and reproducible assessment of the course of the disease and the response to treatment&#46; However&#44; there is insufficient evidence of their usefulness in predicting the outcomes of mild-to-moderate AB&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#8211;3</span></a> The availability of a point-of-care tool allowing us to predict which patients may have an unfavourable course would be very useful for the purpose of preventing adverse events&#44; intensifying monitoring and optimising the use of resources &#40;transfer to hospitals with a PICU&#44; early initiation of respiratory support&#44; etc&#46;&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Lung ultrasound allows the assessment of the extent of pleuropulmonary involvement at the bedside easily and readily and without adverse effects&#46; It has been proven to be useful and in many instances superior to chest radiography in the diagnosis of transient tachypnoea of the newborn&#44; acute respiratory distress syndrome &#40;ARDS&#41;&#44; pneumonia&#44; pleural effusion and pneumothorax&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#8211;11</span></a> Despite the extensive evidence gathered on other acute pulmonary diseases&#44; few studies have assessed the usefulness of lung ultrasound in AB&#46; Studies published to date agree that the extent of lung lesions is associated with the severity of AB&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">12&#8211;14</span></a> It would thus be sound to hypothesise that the extent of lung involvement could be a valuable predictor of the clinical course of AB&#44; as is the case in other diseases such as ARDS&#44; in which it is of proven utility in predicting mortality or response to treatments such as prone ventilation or recruitment maneouvres&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">15&#8211;20</span></a> However&#44; no study to date has assessed the usefulness of early lung ultrasound in predicting the clinical course of AB&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We had 2 main objectives in conducting this study&#58; on the one hand&#44; to analyse the association between lung ultrasound findings and severity in mild-to-moderate AB as assessed by 2 clinical severity scores used in our region&#44; and on the other to analyse whether early lung ultrasound findings are associated with clinical outcomes in patients presenting to hospital with mild-to-moderate AB&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a prospective observational study between October 2016 and March 2017&#46; We defined AB as an episode of respiratory distress characterised by manifestations of lower respiratory tract involvement &#40;wheezing&#44; rales&#41; following an upper respiratory tract infection in infants aged less than 12 months&#44; whether or not this was the first episode of the kind&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> We included patients aged less than 1 year with a clinical diagnosis of mild-to-moderate AB managed in our hospital as long as the lung ultrasound examination was performed by the researchers in the first 24<span class="elsevierStyleHsp" style=""></span>h of care&#46; We excluded patients that presented to the hospital with severe AB &#40;Wood-Downes score modified by Ferr&#233;s &#91;MWDF&#93;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>8 and Hospital Sant Joan de D&#233;u score &#91;HSJD&#93;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10&#41;&#44; patients admitted to the PICU in the first 24<span class="elsevierStyleHsp" style=""></span>h of care&#44; patients with a diagnosis of pneumonia based on sonographic findings&#44; patients with haemodynamically significant congenital heart disease and patients born preterm with a history of bronchopulmonary dysplasia&#44; whose ultrasound features are very similar to those of AB&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Measures</span><p id="par0025" class="elsevierStylePara elsevierViewall">We collected demographic and clinical data for each patient at the time of arrival to hospital&#46; The clinical assessment of the patients included measurement of vital signs and oxygen saturation and calculation of 2 clinical severity scores commonly used in our region &#40;MWDF and HSJD scores&#41; by the physician in charge&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">21&#44;22</span></a> We analysed the clinical outcomes of patients in the month that followed their visit to our hospital &#40;return to emergency department&#44; hospital admission or development of early complications&#41; through the review of electronic health records and telephone calls&#46; We followed up patients admitted to hospital until they were discharged&#44; recording the treatments they received and their clinical outcomes&#46; The primary endpoints were the need for PICU admission&#44; use of invasive mechanical ventilation&#44; length of stay and duration of oxygen therapy&#46; The main criterion for PICU admission was the development of severe respiratory distress&#44; diagnosed based on clinical severity scores&#46; Other criteria used to determine transfer to the PICU were apnoeic episodes&#44; significant hypoxaemia &#40;need of supplemental oxygen at concentrations of more than 50&#37; to achieve a saturation greater than 90&#37;&#41; or hypercapnia&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Lung ultrasound</span><p id="par0030" class="elsevierStylePara elsevierViewall">In adherence with the protocol of the study&#44; all participants underwent a lung ultrasound examination within 24<span class="elsevierStyleHsp" style=""></span>h of arrival to the hospital&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The examination was performed with a portable ultrasound machine &#40;SonoSite M-Turbo&#44; Fujifilm&#44; Japan&#41; and a 6&#8211;13<span class="elsevierStyleHsp" style=""></span>MHz linear array probe in all patients&#46; Two paediatrics resident physicians &#40;observer A and observer B&#41; with previous experience in lung ultrasound performed the lung ultrasound examinations and interpreted their findings&#46; These resident physicians had performed more than 25 lung ultrasound examinations in their clinical practice &#40;mainly for diagnosis of pneumonia and its complications&#41;&#46; They received specific training for this study delivered in two 2-h-long theoretical&#47;practical workshops that included a review and discussion of the sonographic features of AB and performance under supervision of at least 10 lung ultrasound examinations in patients with AB &#40;which were not included in the study&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">23&#8211;25</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The imaging protocol included the examination of 10 chest zones &#40;5 per hemithorax&#41;&#44; capturing a 10-s video clip of each zone &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; All images were recorded digitally for later analysis&#46; The images were analysed in random order&#44; and the evaluators were blinded to the clinical data of the patient to ensure an objective and unbiased interpretation&#46; Three different elements of lung involvement in AB were assessed in each zone&#58; pleural line abnormalities &#40;PAs&#41;&#44; extent of alveolar interstitial syndrome &#40;AIS&#41; and presence of subpleural lung consolidations &#40;SCs&#41;&#46; Pleural line abnormalities were defined as pleural thickening or loss of lung sliding&#59; and graded with a score of 0 points &#40;absence of abnormalities&#41; or 1 point &#40;presence of abnormality&#41; adding to a possible maximum of 10 points for all zones&#46; Interstitial syndrome was graded with a score of 0 points &#40;normal pattern with a predominance of A lines&#41;&#44; 1 point &#40;AIS with converging B lines&#44; defined as 3 or more B lines or white lung&#44; in 1 intercostal space&#41; or 2 points &#40;AIS with convergent B lines&#44; defined as 3 or more B lines per intercostal space or white lung&#44; in 2 adjacent intercostal spaces&#41; with a possible maximum of 20 points&#46; Subpleural consolidation was graded with a score of 0 points &#40;absent&#41;&#44; 1 point &#40;consolidation<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&#41;&#44; and 2 points &#40;consolidation<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm or multiple consolidations&#41; with a possible maximum of 20 points&#46; We calculated the total lung ultrasound score &#40;LUS-Sc&#41; adding the scores for each individual zone&#46; Thus&#44; the maximum possible total score was 50 points &#40;range&#44; 0&#8211;50&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">We summarised the data using the median and interquartile range&#44; and absolute frequencies and percentages&#46; In a first analysis&#44; we assessed the interrater reliability between the paediatricians trained to perform the lung ultrasound examinations and a paediatrician with more than 5 years&#8217; experience in the technique&#46; We analysed the agreement in the assessment of PAs&#44; AIS and the presence and extent of SCs in thirty 10-s clips randomly chosen from all the ultrasound examinations of patients with AB&#46; We used the Cohen kappa coefficient to measure agreement&#44; and considered agreement substantial if kappa was greater than 0&#46;8 and moderate if kappa was greater than 0&#46;6&#44; applying the thresholds proposed by Landi and Koch&#46; We used the intraclass correlation coefficient to assess the degree of interrater agreement&#46; We then analysed the association between the LUS-Sc &#40;total score and PA&#44; AIS and SC subscores&#41; and the clinical parameters of AB severity using the Spearman correlation coefficient&#46; Last of all&#44; we used multivariate regression to assess for the presence of an independent association between the LUS-Sc and the need for admission to the PICU&#44; the length of stay and the duration of oxygen therapy&#46; We considered <span class="elsevierStyleItalic">P</span>-values of less than 0&#46;05 statistically significant&#46; We performed the statistical analysis with the software SPSS version 22&#46;0&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical considerations</span><p id="par0050" class="elsevierStylePara elsevierViewall">The study protocol was evaluated and approved by the Clinical Research Ethics Committee&#44; and the parents or legal guardians of participants provided their written informed consent to their participation in the study and the publication of its results&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">We included 59 patients with mild-to-moderate AB with a median age of 90 days &#40;IQR&#44; 30&#8211;270&#41; and a median weight of 6&#46;1<span class="elsevierStyleHsp" style=""></span>kg &#40;IQR&#44; 4&#46;8&#8211;7&#46;9&#41;&#46; Forty-four patients required hospital admission for a median length of stay of 5 days &#40;IQR&#44; 3&#8211;7&#46;5&#41;&#44; and 37 &#40;84&#37;&#41; required oxygen therapy for a median of 3 days &#40;IQR&#44; 2&#8211;6&#41;&#46; The lung ultrasound examination was performed at the time of admission to the paediatric ward in 41 patients&#44; and in the emergency department in 18&#46; Four patients &#40;6&#46;7&#37;&#41; were admitted to the PICU&#44; and none required invasive mechanical ventilation&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the characteristics of the patients&#44; and Appendix B presents supplementary material&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The interrater agreement between the paediatricians that performed and interpreted the ultrasound examinations and a paediatrician experienced in lung ultrasound was substantial for the assessment of PAs &#40;observer A kappa&#44; 0&#46;851&#59; observer B kappa&#44; 0&#46;841&#41; and of AIS &#40;observer A kappa&#44; 0&#46;836&#59; observer B kappa&#44; 0&#46;877&#41; and moderate for the assessment of SCs &#40;observer A kappa&#44; 0&#46;620&#59; observer B kappa&#44; 0&#46;695&#41;&#46; The interrater intraclass correlation coefficient &#40;absolute agreement between individual measurements&#41; for the total score in the LUS-Sc was 0&#46;917 &#40;95&#37; CI&#44; 0&#46;854&#8211;0&#46;956&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The ultrasound examinations were performed a median of 3 days &#40;IQR&#44; 2&#8211;4&#41; from the onset of symptoms of AB&#46; None of the patients were receiving respiratory support before the examination &#40;except for conventional support with supplemental oxygen delivered via nasal prongs&#41;&#46; The lung zones affected most frequently were the posterior paravertebral and the linea scapularis zones &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The median score in the LUS-Sc was 8 points &#40;IQR&#44; 5&#8211;13&#41; in the overall sample&#44; 6 points &#40;IQR&#44; 2&#8211;8&#41; in the subset of patients discharged home from the emergency department&#44; 9 points &#40;IQR&#44; 5&#8211;13&#46;7&#41; in the subset admitted to the paediatric ward and 17 points &#40;IQR&#44; 14&#46;5&#8211;18&#41; in the subset admitted to the PICU &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; We also found statistically significant differences in the degree of AIS &#40;discharge home&#44; 0 &#91;IQR&#44; 0&#8211;2&#93;&#59; admission to ward&#44; 4&#46;5 &#91;IQR&#44; 3&#8211;6&#93;&#59; transfer to PICU&#44; 5&#46;5 &#91;IQR&#44; 5&#8211;6&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and of SCs &#40;discharge home&#44; 0 &#91;IQR&#44; 0&#8211;2&#93;&#59; admission to ward&#44; 2 &#91;IQR&#44; 0&#8211;3&#46;7&#93;&#59; transfer to PICU&#44; 5 &#91;IQR&#44; 4&#46;2&#8211;5&#46;7&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>004&#41;&#44; but not in the severity of PAs&#46; We did not find significant differences in severity between infants aged less than 3 months and older infants&#58; MWDF score of 5 &#40;IQR&#44; 4&#8211;6&#41; vs 4&#46;5 &#40;IQR&#44; 4&#8211;7&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>459&#41;&#44; and HSJD score of 6 &#40;IQR&#44; 4&#8211;7&#41; vs 5&#46;5 &#40;IQR&#44; 4&#8211;7&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>662&#41;&#46; However&#44; the LUS-Sc scores were higher in infants aged less than 3 months&#58; 9 &#40;IQR&#44; 6&#8211;13&#41; vs 7&#46;5 &#40;IQR&#44; 2&#8211;13&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#46;</span>069&#41;&#44; with a higher AIS subscore &#40;3 &#91;IQR&#44; 1&#8211;5&#93; vs 1 &#91;IQR&#44; 0&#8211;4&#46;5&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;127&#41;&#44; and more SCs &#40;4&#46;5 &#91;IQR&#44; 3&#8211;6&#93; vs 2 &#91;IQR&#44; 0&#8211;4&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;106&#41;&#44; although these differences were not statistically significant&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">We found a statistically significant correlation between the LUS-Sc scores&#44; especially the degree of AIS and SCs&#44; and all clinical parameters except the respiratory rate &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The strongest correlations were between the total LUS-Sc score and the scores in the MWDF &#40;Spearman rho&#44; 0&#46;504&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and the HSJD scales &#40;Spearman rho&#44; 0&#46;518&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> presents the scatterplots for these correlations&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">For every 5-point increase in the LUS-Sc&#44; there were increases in the probability of admission to the PICU &#40;OR&#44; 2&#46;5 &#91;95&#37; CI&#44; 1&#46;1&#8211;5&#46;9&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41;&#44; in length of stay by 1&#46;2 days &#40;95&#37; CI&#44; 0&#46;55&#8211;1&#46;86&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and in duration of oxygen therapy by 0&#46;87 days &#40;95&#37;CI&#44; 0&#46;26&#8211;1&#46;48&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#46; These associations remained significant after adjusting for sex&#44; weight&#44; age&#44; duration of AB symptoms and the presence of risk factors for severe AB &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this preliminary study&#44; we found that lung ultrasound findings were correlated to symptom severity in mild-to-moderate AB and had a certain value in the prediction of the subsequent course of the disease&#46; However&#44; our findings could not prove that they added to the information provided by clinical severity scores for the purpose of anticipating an unfavourable progression&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Very few studies have used lung ultrasound in the context of AB&#44; despite it being a method widely used in the assessment of patients with acute pulmonary diseases such as pneumonia&#44; pleural effusion or lung oedema&#44; in which its diagnostic yield exceeds that of plain X-rays while avoiding exposure to ionising radiation&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">5&#8211;7&#44;12</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In 2011&#44; in a study comparing ultrasound and X-ray findings in patients with AB&#44; Caiulo et al&#46; found that the extent of SCs and AIS was associated with disease severity&#44; and that the number and grading of SCs paralleled the scores in the Downes scale&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">12</span></a> In 2015&#44; Basile et al&#46; assessed the usefulness of ultrasound abnormalities in patients with AB&#44; in terms of the presence and extent of SCs and the degree of AIS&#44; for identification of patients requiring oxygen therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a> Our results were consistent with those of these studies&#44; and we have also found evidence that abnormal ultrasound features exhibit a similar linear correlation with 2 validated clinical severity scores&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">26</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">We ought to mention that our study did not find a linear correlation between respiratory rate &#40;which is widely considered a sensitive marker of respiratory involvement&#41; and lung ultrasound findings&#46; We do not have an obvious explanation for this result&#46; It is possible that the greater variability and the lack of specificity of respiratory rate &#40;due to its association with fever&#44; nasal obstruction&#44; agitation in the patient&#44; etc&#46;&#41; combined with the small sample size contributed to this unexpected result&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Ultrasound findings such as PAs&#44; SCs or the presence of AIS are not specific for AB and overlap significantly with the findings in other diseases with diffuse interstitial involvement&#44; such as bronchopulmonary dysplasia or ARDS&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#44;27</span></a> However&#44; our study and others in the previous literature are a proof of concept and suggest that the degree of sonographic abnormality reflects the severity of the pathophysiological process underlying AB to some extent&#46; We know that the most severe cases of AB are those with presentations similar to that of ARDS&#44; with severe interstitial involvement and a decrease in lung compliance as opposed to a pattern of obstruction and air trapping&#46; It is possible that the early detection of reduced aeration by lung ultrasound could be useful in predicting the course of disease&#46; In our study&#44; we observed that patients that ended up requiring admission to PICU had more extensive involvement in the early ultrasound examination compared to patients discharged home or admitted exclusively to the paediatric ward&#44; and also found that ultrasound was of some value in identifying patients that eventually required longer lengths of stay and more days of oxygen therapy&#46; However&#44; our statistical models did not show that these associations remained significant after adjusting for the clinical severity scores&#46; This is not sufficient reason to definitely rule out the use of ultrasound in AB&#44; but should rather encourage further research on its potential role in this disease&#46; For instance&#44; we observed that in patients with a similar severity determined on the basis of clinical features&#44; ultrasound revealed a greater compromise of lung aeration in infants aged less than 3 months compared to older infants&#44; which could contribute to the more severe course of disease observed in the younger set&#44; in whom alveolar and interstitial involvement may be more prevalent&#44; contrary to the predominance of obstruction and air trapping in older infants&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">All current clinical practice guidelines agree that routine use of diagnostic tests is not recommended in AB&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#44;2</span></a> However&#44; ultrasound examination could be useful in cases where despite performing the routine clinical assessment the need for inpatient observation remains unclear&#46; Sonographic evidence of extensive involvement should alert us to the possibility of progression to severe disease&#46; Thus&#44; in our study&#44; a LUS-Sc score of more than 13&#46;5 points had a sensitivity of 100&#37; and a specificity of 82&#37; in predicting admission to the PICU&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Limitations</span><p id="par0110" class="elsevierStylePara elsevierViewall">The findings of our study must be interpreted taking into account its limitations&#46; The ultrasound examination was performed a median of 3 days after the onset of AB&#44; and while this is the time when symptoms usually peak&#44; it is possible that there were differences between patients in the degree of lung involvement and that the administration of aerosol therapy affected the sonographic findings&#46; However&#44; there is no evidence in the literature that bronchodilators modify the course of disease or the sonographic features of lung involvement in AB&#46; Our study included few patients&#44; who also had relatively low scores &#40;median of 8 points&#41; in an ultrasound-based scale with a maximum possible score of 50 points&#46; This may have limited the power of our study to detect an independent association between ultrasound findings and course of disease&#44; which in the epidemic season under study tended to be relatively benign &#40;short lengths of stay and few admissions to the PICU&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The ultrasound score used in our study assessed more zones per lung than previous studies&#44; which may affect its reproducibility and applicability to clinical practice&#46; Our data suggest that the assessment of the number and extent of SCs may be somewhat subjective&#44; as the interrater agreement was only moderate&#46; Also&#44; it seems that the assessment of PAs adds little to the information provided by the assessment of SC and AIS&#44; so in future studies it might be convenient to simplify the score by eliminating this dimension&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the future&#44; as the availability of ultrasound equipment and the training of paediatricians in ultrasound grow&#44; the use of this technique in the management of respiratory diseases may become routine&#46; However&#44; to reach the full potential of lung ultrasound&#44; systematic and validated assessment protocols need to be developed&#46; In our opinion&#44; future studies should focus on detecting which findings are most useful in predicting the course of AB&#46; This would require the inclusion of enough patients that progress to severe forms and need mechanical ventilation&#44; so multicentre studies would be preferable to ensure adequate recruitment&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0125" class="elsevierStylePara elsevierViewall">We found a moderate correlation between the clinical severity scores and the degree of lung involvement evinced by early ultrasound examination in infants with mild-to-moderate AB&#46; The most useful sonographic findings were those concerning the degree of AIS and SC&#46; Lung ultrasound findings may be associated with clinical course and be useful to identify patients at risk of progression to severe disease&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Funding</span><p id="par0130" class="elsevierStylePara elsevierViewall">XIX Clinical and Epidemiological Research Grant Competition&#8212;2016&#44; Fundaci&#243;n Ernesto S&#225;nchez Villares&#44; Sociedad de Pediatr&#237;a de Asturias&#44; Cantabria y Castilla y Le&#243;n&#46; Project 02&#47;2016&#58; <span class="elsevierStyleItalic">Utilidad de la ecograf&#237;a pulmonar en la valoraci&#243;n de la gravedad y pron&#243;stico de la bronquiolitis aguda&#46;</span> Principal investigator&#58; Elia Zoido Garrote&#46; Grant of 3000 euro&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the correlation between the findings seen in early lung ultrasound with the clinical severity scales&#44; and its association with the subsequent progression of the mild&#8211;moderate acute bronchiolitis &#40;AB&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An observational prospective study conducted on infants with mild&#8211;moderate AB&#44; using lung ultrasound in the first 24<span class="elsevierStyleHsp" style=""></span>h of hospital care&#46; The lung involvement was graded &#40;range 0&#8211;50 points&#41; based on an ultrasound score &#40;ScECO&#41; and 2 routinely used clinical scales&#58; the modified Wood Downes Ferres &#40;WDFM&#41;&#44; and the Hospital Sant Joan de Deu &#40;HSJD&#41;&#46; The relationship between the ScECO and the subsequent clinical progression &#40;admission to the Paediatric Intensive Care Unit &#40;PICU&#41;&#44; days in hospital&#44; and days of oxygen therapy&#41; was also determined&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The study included a total of 59 patients&#44; with a median age of 90 days &#40;IQR&#58; 30&#8211;270 days&#41;&#46; The median ScECO score was 6 points &#40;2&#8211;8&#41; in the patients that did not require hospital admission&#44; with 9 points &#40;5&#8211;13&#46;7&#41; admitted to the ward&#44; and 17 &#40;14&#46;5&#8211;18&#41; in the patients who needed to be transferred from the ward to the PICU &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The ScECO had a moderate lineal association with the WDFM scale &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;504&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and the HSJD &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;518&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; The ScECO was associated with admission to PICU &#91;OR 2&#46;5 &#40;95&#37; CI&#58; 1&#46;1&#8211;5&#46;9&#41;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#93;&#44; longer hospital stay &#91;1&#46;2 days &#40;95&#37; CI&#58; 0&#46;55&#8211;1&#46;86&#41;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#93; and duration of oxygen therapy &#91;0&#46;87 days &#40;95&#37; CI&#58; 0&#46;26&#8211;1&#46;48&#41;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#93;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is a moderate correlation between early lung ultrasound findings with the severity of the AB evaluated by the clinical scales&#44; as well as some relationship with the clinical progression&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la correlaci&#243;n entre hallazgos de la ecograf&#237;a pulmonar realizada precozmente con las escalas de gravedad cl&#237;nica y su asociaci&#243;n con la evoluci&#243;n posterior en la bronquiolitis aguda &#40;BA&#41; leve-moderada&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional prospectivo&#46; Se incluy&#243; a lactantes con BA leve-moderada evaluados mediante ecograf&#237;a pulmonar en las primeras 24 h tras la atenci&#243;n hospitalaria&#46; Se gradu&#243; la afectaci&#243;n pulmonar &#40;rango 0-50 puntos&#41; sobre la base de un score ecogr&#225;fico &#40;ScECO&#41;&#46; Se evalu&#243; la correlaci&#243;n entre el ScECO y 2 escalas cl&#237;nicas de uso habitual&#58; escala de Wood Downes Ferres modificada &#40;WDFM&#41; y escala del Hospital Sant Joan de D&#233;u &#40;HSJD&#41;&#46; As&#237; mismo se valor&#243; la asociaci&#243;n entre el ScECO y la evoluci&#243;n cl&#237;nica posterior &#40;ingreso en la Unidad de Cuidados Intensivos Pedi&#225;tricos &#91;UCIP&#93;&#44; d&#237;as de hospitalizaci&#243;n y d&#237;as de oxigenoterapia&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 59 pacientes con una edad mediana de 90 d&#237;as &#40;RIQ&#58; 30-270 d&#237;as&#41;&#46; La puntuaci&#243;n mediana del ScECO fue de 6 puntos &#40;2-8&#41; en los pacientes que no requirieron ingreso&#44; 9 &#40;5-13&#44;7&#41; en los ingresados en planta y 17 &#40;14&#44;5-18&#41; en los pacientes que precisaron traslado de planta a la UCIP &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El ScECO tuvo una correlaci&#243;n lineal moderada con la escala de WDFM &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;504&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y HSJD &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;518&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; El ScECO se asoci&#243; al ingreso en UCIP &#40;OR 2&#44;5 &#91;IC del 95&#37;&#58; 1&#44;1-5&#44;9&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;035&#41;&#44; mayor estancia hospitalaria &#40;1&#44;2 d&#237;as &#91;IC del 95&#37;&#58; 0&#44;55&#44; 1&#44;86&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y duraci&#243;n de oxigenoterapia &#40;0&#44;87 d&#237;as &#91;IC del 95&#37;&#58; 0&#44;26&#44; 1&#44;48&#93;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a pulmonar precoz se correlaciona de forma moderada con la gravedad de la BA evaluada por escalas cl&#237;nicas y guarda cierta relaci&#243;n con la evoluci&#243;n cl&#237;nica&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Zoido Garrote E&#44; Garc&#237;a Aparicio C&#44; Camila Torrez Villarroel C&#44; Pedro Vega Garc&#237;a A&#44; Mu&#241;iz Font&#225;n M&#44; Oulego Erroz I&#46; Utilidad de la ecograf&#237;a pulmonar precoz en bronquiolitis aguda leve-moderada&#58; estudio piloto&#46; An Pediatr &#40;Barc&#41;&#46; 2019&#59;90&#58;10&#8211;18&#46;</p>"
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            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
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            "titulo" => "Supplementary data"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Protocol for lung ultrasound acquisition and interpretation&#46; The scanned zones are marked with numbers&#46; The ultrasound score is noted in the images labelled with letters&#46; The images show the score assigned to each detected abnormality&#46; &#40;b&#41; Normal lung&#58; 0 points&#46; &#40;c&#41; Pleural thickening&#46; LUS-Sc&#58; 1 point&#46; &#40;d&#41; Focal AIS focal&#46; LUS-Sc&#58; 1 point&#46; &#40;e&#41; Diffuse AIS&#46; LUS-Sc&#58; 2 points&#46; &#40;f&#41; SCs<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&#46; LUS-Sc&#58; 1 point&#46; &#40;g&#41; SCs<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>cm&#46; LUS-Sc&#58; 2 points&#46; AIS&#44; alveolar interstitial syndrome&#59; SC&#44; subpleural consolidation&#59; 1&#58; anterior parasternal zone&#59; 2&#58; anterior axillary zone&#59; 3&#58; posterior axillary zone&#59; 4 posterior paravertebral zone&#59; 5&#58; posterior linea scapularis zone&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Characteristics of Acute Bronchiolitis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;62&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;30&#8211;270&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Weight &#40;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;1 &#40;4&#46;8&#8211;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Length &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;56&#8211;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Risk factors for AB</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;49&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Duration of symptoms</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleBold">Severity of AB</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">MWDF score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a&#46; Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b&#46; Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;79&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HSJD score</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;4&#8211;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a&#46; Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;42&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b&#46; Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;57&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Hospitalisation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Inpatient treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>a&#46; Oxygen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;84&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>b&#46; HS 3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;31&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>c&#46; Bronchodilators&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>d&#46; Bronchodilators<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>HS 3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>d&#46; Systemic corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>e&#46; Antibiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>f&#46; Intravenous fluid therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;13&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Outcomes</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Duration of oxygen therapy &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Length of stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#8211;7&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Admission to PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Invasive mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Lung ultrasound &#40;total score&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#8211;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AIS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SCs&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">We assessed the association between the ultrasound score and admission to the PICU by logistic regression&#44; and the association of the ultrasound score and the length of stay and the duration of oxygen therapy with linear regression&#46; We present the ORs and B coefficients for 5-point increases in the ultrasound score with the corresponding 95&#37; confidence intervals and <span class="elsevierStyleItalic">P</span>-values&#46; The model was adjusted for sex&#44; weight&#44; age&#44; duration of AB and presence of risk factors for severe AB &#40;age<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>6 weeks&#44; preterm birth<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>35 weeks&#8217; gestation&#44; underlying chronic disease or absence of exclusive breastfeeding&#41;&#46;</p>"
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                    0 => array:2 [
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                            1 => "G&#46; Claret Teruel"
                            2 => "C&#46; Luaces Cubells"
                            3 => "M&#46;D&#46; Estrada Sabadell"
                            4 => "J&#46; Pou Fern&#225;ndez"
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              "identificador" => "bib0150"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Conferencia de consenso sobre bronquiolitis aguda &#40;<span class="elsevierStyleSmallCaps">iii</span>&#41;&#58; diagn&#243;stico en la bronquiolitis aguda&#46; Revisi&#243;n de la evidencia cient&#237;fica"
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                            0 => "C&#46; Ochoa Sangrador"
                            1 => "J&#46; Gonz&#225;lez de Dios"
                          ]
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ultrasound diagnosis of pneumonia in children"
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                          "autores" => array:2 [
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                    0 => array:2 [
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                        "tituloSerie" => "Radiol Med"
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                        "volumen" => "113"
                        "paginaInicial" => "190"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18386121"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
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                            3 => "P&#46; Fracasso"
                            4 => "F&#46;D&#46; Marco"
                            5 => "M&#46; Mandelli"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000362692"
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                        "tituloSerie" => "Respiration"
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                        "volumen" => "88"
                        "paginaInicial" => "112"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24992951"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Lung ultrasound&#58; its role in neonatology and pediatrics"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Cattarossi"
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                        "tituloSerie" => "Early Hum Dev"
                        "fecha" => "2013"
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                        "paginaInicial" => "S17"
                        "paginaFinal" => "S19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23809341"
                            "web" => "Medline"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential of ultrasound in the pediatric chest"
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Eur J Radiol"
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                        "paginaFinal" => "1518"
                        "link" => array:1 [
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                        "link" => array:1 [
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                    0 => array:2 [
                      "titulo" => "Application of lung ultrasonography in the diagnosis of childhood lung diseases"
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                        "tituloSerie" => "Chin Med J &#40;Engl&#41;"
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                        "link" => array:1 [
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                        "link" => array:1 [
                          0 => array:2 [
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                      "titulo" => "Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress"
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                            3 => "C&#46; Arbelot"
                            4 => "J&#46;M&#46; Constantin"
                            5 => "Q&#46; Lu"
                          ]
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                      ]
                    ]
                  ]
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                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2012"
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                        "paginaFinal" => "2072"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22584759"
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                ]
              ]
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                      "titulo" => "Bronchiolitis Score of Sant Joan de D&#233;u&#58; BROSJOD Score&#44; validation and usefulness"
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                          "etal" => true
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                            3 => "E&#46; Esteban"
                            4 => "J&#46;L&#46; Carrasco"
                            5 => "F&#46;J&#46; Cambra"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Pediatr Pulmonol"
                        "fecha" => "2017"
                        "volumen" => "52"
                        "paginaInicial" => "533"
                        "paginaFinal" => "539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28328090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Adrenalina subcut&#225;nea versus salbutamol inhalado en el tratamiento de la crisis asm&#225;tica infantil"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Ferres Mataro"
                            1 => "M&#46;A&#46; Mangues Bafalluy"
                            2 => "R&#46; Farre Riba"
                            3 => "A&#46; Julia"
                            4 => "J&#46; Bonal de Falgas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1987"
                        "volumen" => "27"
                        "paginaInicial" => "37"
                        "paginaFinal" => "40"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3662253"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "23"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Learning curves in emergency ultrasound education"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;J&#46; Blehar"
                            1 => "B&#46; Barton"
                            2 => "R&#46;J&#46; Gaspari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/acem.12653"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "paginaInicial" => "574"
                        "paginaFinal" => "582"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25903780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0255"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The learning curve of resident physicians using emergency ultrasonography for obstructive uropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;B&#46; Jang"
                            1 => "R&#46; Jack Casey"
                            2 => "P&#46; Dyne"
                            3 => "A&#46; Kaji"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1553-2712.2010.00850.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Emerg Med"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "1024"
                        "paginaFinal" => "1027"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20836789"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Point-of-care ultrasonography by pediatric emergency medicine physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;R&#46; Marin"
                            1 => "R&#46;E&#46; Lewiss"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PEC.0000000000000492"
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Emerg Care"
                        "fecha" => "2015"
                        "volumen" => "31"
                        "paginaInicial" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26148103"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                      "titulo" => "Validaci&#243;n de una escala cl&#237;nica de gravedad de la bronquiolitis aguda"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Ramos Fern&#225;ndez"
                            1 => "A&#46; Cord&#243;n Mart&#237;nez"
                            2 => "R&#46; Galindo Zavala"
                            3 => "A&#46; Urda Cardona"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
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                        "volumen" => "81"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
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                    ]
                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Ecograf&#237;a pulmonar&#58; &#191;ha llegado el momento&#63;"
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                          "etal" => false
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                      "Revista" => array:4 [
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2018.03.004

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Year/Month	Html	Pdf	Total

2024 November	10	14	24
2024 October	72	46	118
2024 September	73	48	121
2024 August	79	58	137
2024 July	102	34	136
2024 June	66	38	104
2024 May	45	34	79
2024 April	52	40	92
2024 March	39	22	61
2024 February	34	29	63
2024 January	30	32	62
2023 December	74	28	102
2023 November	40	29	69
2023 October	37	26	63
2023 September	39	30	69
2023 August	30	16	46
2023 July	33	24	57
2023 June	34	22	56
2023 May	36	23	59
2023 April	38	19	57
2023 March	43	25	68
2023 February	45	24	69
2023 January	24	21	45
2022 December	56	30	86
2022 November	62	29	91
2022 October	63	56	119
2022 September	35	33	68
2022 August	42	47	89
2022 July	49	59	108
2022 June	32	36	68
2022 May	59	41	100
2022 April	55	34	89
2022 March	59	47	106
2022 February	37	33	70
2022 January	47	34	81
2021 December	36	40	76
2021 November	55	38	93
2021 October	86	66	152
2021 September	56	40	96
2021 August	62	44	106
2021 July	40	37	77
2021 June	41	41	82
2021 May	47	39	86
2021 April	112	106	218
2021 March	86	37	123
2021 February	75	31	106
2021 January	83	25	108
2020 December	64	17	81
2020 November	48	24	72
2020 October	59	21	80
2020 September	65	31	96
2020 August	53	17	70
2020 July	44	13	57
2020 June	61	13	74
2020 May	74	29	103
2020 April	62	29	91
2020 March	39	14	53
2020 February	27	21	48
2020 January	50	28	78
2019 December	56	26	82
2019 November	49	15	64
2019 October	46	23	69
2019 September	40	21	61
2019 August	39	25	64
2019 July	35	36	71
2019 June	28	25	53
2019 May	73	17	90
2019 April	74	34	108
2019 March	55	23	78
2019 February	41	21	62
2019 January	104	36	140
2018 December	43	23	66
2018 November	8	6	14

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