Can lung ultrasonography reduce chest X-ray use in children with suspected pneumonia?

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Why is this study important?

Lung ultrasonography (LUS) has been reported as an effective diagnostic tool for pneumonia in adult and pediatric patients.[1][2][3] If LUS can reduce chest X-ray (CXR) use, the potential benefits include reduced radiation exposure and ED length of stay (LOS) and possibly reduced health care costs. Since LUS cannot distinguish between viral and bacterial pneumonia, it cannot be expected to decrease antibiotic use.

Which, if any, threats to validity are most likely to have an impact on the results and how?

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