Diagnostic accuracy of point-of-care lung ultrasound compared to chest radiography for identifying community-acquired pneumonia in children: a systematic review and meta-analysis

Abstract

Chest radiography (CXR) is the conventional imaging standard for diagnosing community-acquired pneumonia (CAP) in children. However, concerns regarding diagnostic variability and ionizing radiation exposure have prompted interest in alternative modalities. Point-of-care ultrasound (POCUS) has emerged as a promising, radiation-free diagnostic tool. To systematically compare the diagnostic accuracy of POCUS versus CXR for detecting CAP in pediatric patients. A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, and the Cochrane Library were searched from inception through September 2025. Studies meeting predefined PICOS criteria included pediatric patients (≤ 18 years) with suspected CAP undergoing POCUS and/or CXR, using clinical assessment or computed tomography as reference standards. Pooled sensitivity, specificity, and summary receiver operating characteristic (SROC) curves were calculated using a random-effects model. Study quality was assessed using the QUADAS-2 tool. Twenty studies comprising 2,984 pediatric patients were included. POCUS demonstrated a pooled sensitivity of 91% (95% CI: 89–93%) and specificity of 86% (95% CI: 83–88%). In comparison, CXR showed a sensitivity of 88% (95% CI: 87–90%) and specificity of 76% (95% CI: 71–80%). SROC analysis indicated superior diagnostic performance for POCUS (AUC 0.9569) versus CXR (AUC 0.9291). POCUS more consistently detected pulmonary consolidation and pleural effusion. POCUS demonstrates superior diagnostic accuracy compared with CXR for pediatric CAP, with higher specificity and a trend toward improved sensitivity. These findings support POCUS as an accurate, non-ionizing, first-line imaging modality for diagnosing CAP in children.