Background Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID‐19. Previously described LUS manifestations for COVID‐19 include B‐lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID‐19 is unknown. Methods This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans ( n = 180 independent observations) collected from patients with COVID‐19, diagnosed via RT‐PCR. These studies were randomly selected from an image database consisting of COVID‐19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values ( κ ) were used to calculate IRR. Results There was substantial IRR on the following items: normal LUS scan ( κ = 0.79 [95% CI: 0.72–0.87]), presence of B‐lines ( κ = 0.79 [95% CI: 0.72–0.87]), ≥3 B‐lines observed ( κ = 0.72 [95% CI: 0.64–0.79]). Moderate IRR was observed for the presence of any consolidation ( κ = 0.57 [95% CI: 0.50–0.64]), subpleural consolidation ( κ = 0.49 [95% CI: 0.42–0.56]), and presence of effusion ( κ = 0.49 [95% CI: 0.41–0.56]). Fair IRR was observed for pleural thickening ( κ = 0.23 [95% CI: 0.15–0.30]). Discussion Many LUS manifestations for COVID‐19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID‐19 may include the presence/count of B‐lines or determining if a scan is normal. Clinical protocols for LUS with COVID‐19 may require additional observers for the confirmation of less reliable findings such as consolidations.

Objectives Lung ultrasound (LUS) can accurately diagnose several pulmonary diseases, including pneumothorax, effusion, and pneumonia. LUS may be useful in the diagnosis and management of COVID‐19. Methods This study was conducted at two United States hospitals from 3/21/2020 to 6/01/2020. Our inclusion criteria included hospitalized adults with COVID‐19 (based on symptomatology and a confirmatory RT‐PCR for SARS‐CoV‐2) who received a LUS. Providers used a 12‐zone LUS scanning protocol. The images were interpreted by the researchers based on a pre‐developed consensus document. Patients were stratified by clinical deterioration (defined as either ICU admission, invasive mechanical ventilation, or death within 28 days from the initial symptom onset) and time from symptom onset to their scan. Results N = 22 patients (N = 36 scans) were included. Eleven (50%) patients experienced clinical deterioration. Among N = 36 scans, only 3 (8%) were classified as normal. The remaining scans demonstrated B‐lines (89%), consolidations (56%), pleural thickening (47%), and pleural effusion (11%). Scans from patients with clinical deterioration demonstrated higher percentages of bilateral consolidations (50 versus 15%; P = .033), anterior consolidations (47 versus 11%; P = .047), lateral consolidations (71 versus 29%; P = .030), pleural thickening (69 versus 30%; P = .045), but not B‐lines (100 versus 80%; P = .11). Abnormal findings had similar prevalences between scans collected 0–6 days and 14–28 days from symptom onset. Discussion Certain LUS findings may be common in hospitalized COVID‐19 patients, especially for those that experience clinical deterioration. These findings may occur anytime throughout the first 28 days of illness. Future efforts should investigate the predictive utility of these findings on clinical outcomes.

Since the introduction of point-of-care ultrasound (POCUS) in the 1950s, clinical applications have expanded across various specialties (Moore & Copel, 2011;Solomon & Saldana, 2014;Jackson et al., 2021). The growing use and potential benefits of POCUS raises the question of how this skill is acquired and taught. At the resident level, the Accreditation Council for Graduate Medical Education (ACGME) developed POCUS milestones in selected residencies (ACGME, 2021a, b). At the undergraduate medical education level, the Liaison Committee on Medical Education has no established requirements for POCUS curricula. Some have questioned how to specifically integrate POCUS into an already saturated undergraduate medical education program, especially given limited evidence that POCUS

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