Lung Assessment with Point-of-Care Ultrasound in Respiratory Coronavirus Disease (COVID-19): A Prospective Cohort Study

Speidel, Victor; Conen, Anna; Gisler, Valentin; Fux, Christoph A; Haubitz, Sebastian

doi:10.1016/j.ultrasmedbio.2020.12.021

Cited by 16 publications

(19 citation statements)

References 27 publications

(44 reference statements)

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“…Sensitivity of LUS ranged between 68% and 100% and specificity ranged between 21% and 97%. (11)(12)(13)(14)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) Comparison to RT-PCR testing. Fifteen studies used RT-PCR as the reference standard.…”

Section: Summary Of Results An Overview Of the Characteristics Of All The Included Studies Ismentioning

confidence: 99%

Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis

Matthies

Trauer

Chopra

et al. 2021

Preprint

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Background. Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. The necessity for rapid testing combined with the limitations of other diagnostic tests has led to the proposal of various potential roles for LUS during the COVID-19 pandemic. This systematic review and meta-analysis focused specifically on the diagnostic accuracy of LUS in adult patients presenting with suspected COVID-19. Methods. Traditional and grey-literature searches were performed on June 1st 2021. Two authors independently carried out the searches, selected studies and completed the Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2). Meta-analysis was carried out using established open-source packages in R. We report overall sensitivity, specificity, positive and negative predictive values and the hierarchical summary receiver operating characteristic curve for LUS. Heterogeneity was determined using the I2 statistic. Results. Twenty studies were included, providing data from a total of 4,314 patients. The prevalence and admission rates were generally high across all studies. Overall LUS was found to be 87.2% sensitive (95% CI 83.6-90.2) and 69.5% specific (95% CI 62.2-72.5) and demonstrated overall positive and negative predictive values of 3.0 (95% 2.3-4.1) and 0.16 (95% 0.12-0.22) respectively. Separate analyses for each reference standard revealed similar sensitivities and specificities for LUS. Heterogeneity between studies was found to be high, and QUADAS-2 assessment identified risks of bias in many studies. Conclusion. During a period of high prevalence, LUS is a highly sensitive diagnostic test for COVID-19. However, more research is required to confirm these results in more generalisable populations, including those less likely to be admitted to hospital.

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Section: Summary Of Results An Overview Of the Characteristics Of All The Included Studies Ismentioning

confidence: 99%

Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis

Matthies

Trauer

Chopra

et al. 2021

Preprint

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“…Similar associations between B line density, number of affected zones and clinical severity have been previously reported. 8 Additionally, number of involved areas even when used alone were a significant predictor of severe disease. In the setting of limited hospital resources strained by the ongoing pandemic, this finding may allow lung ultrasonography to aid in the identification of patients likely to require ICU care.…”

Section: Discussionmentioning

confidence: 99%

“…Lung ultrasound is a useful alternative to chest CT or chest X-ray for the diagnosis and follow up of COVID-19 patients 4,8 but inadequate evidence exists regarding its triage capabilities. The results of this study, which involved a systematic 14-zone lung ultrasound assessment of 60 admitted patients with COVID-19 show that the severity and outcomes correlate with the number of involved areas and the severity of involvement (no.…”

Section: Discussionmentioning

confidence: 99%

Clinical correlation of lung ultrasound profiles in patients with COVID-19 infection

Nagpal

Kumar

Wig

et al. 2021

Preprint

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Background: Lung ultrasound is a popular point of care test that correlates well with computed tomography for lung pathologies. While previous studies have shown its ability to detect COVID-19 related lung pathology, we aimed to evaluate the utility of lung ultrasound in the triage and prognostication of COVID-19 patients by determining its ability to predict clinical severity and outcomes. Methods: This was a prospective, cross-sectional, observational, single centre study done at JPNATC and AIIMS, New Delhi, India. Consenting eligible patients aged 18 years or more were included if hospitalised with microbiologically confirmed COVID-19 and classified as mild, moderate (respiratory rate >24/min OR SpO2<94% on room air) and severe COVID-19 (respiratory rate >30/min OR SpO2<90% on room air) at the time of enrolment. The lungs were systematically assessed with ultrasound after division into 14 zones (4 anteriorly, 4 axillary and 6 posteriorly). Clinical and laboratory parameters including arterial blood gas analysis at the time of evaluation were recorded. Patients were followed till death or discharge. The primary objective was to determine the correlation between clinical severity and lung ultrasound profiles (no. of A, B and C profiles, and the total number of areas involved). Secondary objectives included assessment of the correlation between lung ultrasound profiles and clinical outcomes and development of a statistical model incorporating ultrasound and clinical parameters to allow prediction of COVID-19 related severity and outcomes. Findings: Between October 1, 2020, and January 31,2021, patients were screened for inclusion and total n=60 patients were evaluated and included in the final analysis. The most common abnormality seen were B lines, seen in at least one zone in n=53 (88.33%) of cases. A median of 9 (IQR: 5-12) zones of the 14 assessed had a B-profile. The total number of abnormal areas (zones with a B or C profile) correlated significantly with the PaO2/FiO2 ratio (ρ= -0.7232, p<0.0001) and SpO2/FiO2 ratio (ρ= -0.6866, p<0.0001), and differed significantly between mild and moderate vs severe cases (p=0.0026 mild vs moderate, p<0.0001 mild vs severe, p=0.0175 moderate vs severe). The total number of B lines were predictors of mortality (p=0.0188, OR 1.03, 95% CI 1.003-1.060). Statistical models that incorporated total number of B-lines, CRP and anticoagulation use could predict mortality (p=0.0124, pseudo R2=0.1740) with an AUC= 0.7682 (95% CI=0.6176-0.9188), and the total number of involved areas and LDH levels could distinguish severe disease from mild/moderate disease (p<0.0001, Pseudo R2=0.3822), AUC = 0.8743 (95% CI=0.7752-0.9733). A simplified cut off of ≥6 involved areas (of the 14 assessed) was 100% sensitive and 52% specific for differentiating severe disease from mild and moderate ones. Interpretation: In patients with COVID-19, increasing involvement of the lungs as assessed by ultrasonography correlates significantly with clinical severity and outcomes. These findings may be utilized in future prospective studies to validate the use of lung ultrasound to triage and prognosticate patients with COVID-19 infection.

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“…B-lines are vertical hyperechoic laser-like rays arising from the pleural line and extended to the edge of the screen, which move with respiration (a sign called lungsliding). The B-line pattern is the most characteristic sign in COVID-19 with different varieties (separated B-lines, focal, multifocal, coalescent, "rocket sign", "light beam"), reported by most of the studies, with a predominantly posterior and inferior distribution [19][20][21][22][23][24]. The B-lines can coexist with A-lines, in the context of good aeration, called spared areas.…”

Section: Lus Techniquementioning

confidence: 99%

Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

Ciurba

Sárközi

Szabó

et al. 2021

Acta Marisiensis - Seria Medica

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Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.

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Lung Assessment with Point-of-Care Ultrasound in Respiratory Coronavirus Disease (COVID-19): A Prospective Cohort Study

Cited by 16 publications

References 27 publications

Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis

Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: A systematic review and meta-analysis

Clinical correlation of lung ultrasound profiles in patients with COVID-19 infection

Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

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