Diagnostic accuracy of point-of-care lung ultrasound in COVID-19

Abstract

BackgroundA promising modality for diagnosing pulmonary manifestations of COVID-19 in the emergency department (ED) is point-of-care ultrasound (POCUS) of the lungs. The currently used PCR as well as chest X-ray and CT scanning have important disadvantages. The aim of this study is to evaluate the diagnostic accuracy of POCUS in patients with suspected pulmonary manifestations of COVID-19 in the ED.MethodsThis prospective diagnostic accuracy study was conducted at the ED of our non-academic level 1 trauma centre (Isala, Zwolle, the Netherlands). Patients were enrolled between 14 April and 22 April 2020. Patients (aged ≥16 years) with suspected COVID-19 presenting to the ED underwent POCUS. All patients received current standard of care, including PCR (naso-oropharyngeal swab). Outcome of POCUS was compared with PCR or CT scan outcome to determine diagnostic accuracy. Diagnostic accuracy measures were calculated using 2×2 contingency tables.Results100 patients were eligible to participate in this study, data of 93 patients were analysed. 27 (29%) patients were found positive for COVID-19 by PCR or CT. POCUS had a sensitivity of 89% (95% CI 70% to 97%), specificity of 59% (95% CI 46% to 71%), negative predictive value of 93% (95% CI 79% to 98%) and positive predictive value of 47% (95% CI 33% to 61%). In a subgroup of patients without previous cardiopulmonary disease (n=37), POCUS had a sensitivity of 100% (95% CI 70% to 100%), specificity of 76% (95% CI 54% to 90%), negative predictive value of 100% (95% CI 79% to 100%) and positive predictive value of 67% (95% CI 41% to 86%).ConclusionPOCUS of the lungs could serve as a valuable, radiation-free tool for excluding pulmonary manifestations of COVID-19 in patients in the ED at the point of assessment, especially in patients without previous cardiopulmonary disease.Trial registrationDutch Trial Register, No: NTR8544.

Correlation between lung ultrasound and chest CT patterns with estimation of pulmonary burden in COVID-19 patients

“…In the current study, almost all patients with lung abnormalities on the chest CT scan were correctly classified as positive by LUS, showing its reliability for case identification. This corresponds with the current results of the literature, which reports a very high sensitivity (89-100%) for the diagnosis of COVID-19[ [29] , [30] , [31] ].…”

Differences in Clinical Characteristics and Chest Images between Coronavirus Disease 2019 and Influenza-Associated Pneumonia

“…Although our study did not evaluate the diagnostic performance of lung ultrasound, lung ultrasounds have been previously studied for diagnosing and evaluating the clinical course of patients with COVID-19. A prior study reported that point-of-care lung ultrasound had a sensitivity of 89% and specificity of 59% [24]. Even though there is no known pathognomic ultrasound finding for COVID-19, ultrasound can detect pulmonary dynamics for patients with COVID-19 [25].…”

A Pictorial Review of the Role of Imaging in the Detection, Management, Histopathological Correlations, and Complications of COVID-19 Pneumonia

“…LUS is a low-cost imaging technique that is quick to perform and repeat at the bedside by emergency physicians, intensivists, or cardiologists (point-of-care (POC) LUS). This technique allows a dynamic study of the lung without ionizing radiation exposure and with a reduced overall nosocomial transmission risk, also useful in vulnerable groups such as children and pregnant women [ 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. LUS can detect bilateral, subpleural, mainly posterobasal interstitial–alveolar damage in COVID-19 pneumonia with the appearance of thickening/irregularity of the pleural line, increased B lines to different degrees of extension with focal pleural B lines in the early stage of the disease, and multiple coalescent B lines (white lung) in critically ill patients [ 53 , 54 , 56 ].…”

“…However, LUS cannot accurately detect the presence of air bronchogram as well as pneumothorax [ 57 , 58 ]. Some authors have noted that LUS may have a potential role in EDs for triaging symptomatic patients, managing ventilation, weaning ICU patients, and monitoring COVID-19 pneumonia and its evolution toward ARDS in critically ill patients [ 49 , 50 , 51 , 55 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. A focused cardiac ultrasound study (FoCUS) performed at the bedside can also be useful in COVID-19 patients with cardiac events [ 64 ].…”