Lung Ultrasonography for Risk Stratification in Patients with Coronavirus Disease 2019 (COVID-19): A Prospective Observational Cohort Study

Abstract

Background Point-of-care lung ultrasound (LUS) is a promising pragmatic risk stratification tool in COVID-19. This study describes and compares LUS characteristics between patients with different clinical outcomes Methods Prospective observational study of PCR-confirmed COVID-19 adults with symptoms of lower respiratory tract infection in the emergency department (ED) of Lausanne University Hospital. A trained physician recorded LUS images using a standardized protocol. Two experts reviewed images blinded to patient outcome. We describe and compare early LUS findings (acquired within 24hours of presentation to the ED) between patient groups based on their outcome at 7 days after inclusion: 1) outpatients, 2) hospitalised and 3) intubated/death. Normalized LUS score was used to discriminate between groups Results Between March 6 and April 3 2020, we included 80 patients (17 outpatients, 42 hospitalized and 21 intubated/dead). 73 patients (91%) had abnormal LUS (70% outpatients, 95% hospitalised and 100% intubated/death; p=0.003). The proportion of involved zones was lower in outpatients compared with other groups (median 30% [IQR 0-40%], 44% [31-70%] and 70% [50-88%], p<0.001). Predominant abnormal patterns were bilateral and multifocal spread thickening of the pleura with pleural line irregularities (70%), confluent B lines (60%) and pathologic B lines (50%). Posterior inferior zones were more often affected. Median normalized LUS score had a good level of discrimination between outpatients and others with area under the ROC of 0.80 (95% CI 0.68-0.92) Conclusions Systematic LUS has potential as a reliable, cheap and easy-to-use triage tool for the early risk stratification in COVID-19 patients presenting in EDs

Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: a prospective noninterventional study

“…Given the extensive lung involvement in COVID-19 patients, LUS may have some potential utility in the management of acutely ill patients [15,16]. Some studies have reported an improvement in lung involvement assessment in COVID-19 by using LUS in the context of ED and ICU [17,18], but we only have found two prospective studies analyzing the prognostic value of LUS during the first pandemic wave of COVID-19 (March & April 2020) [19]. The first included 80 patients (17 outpatients, 42 hospitalized and 21 with orotracheal intubation or death), initially admitted to ED.…”

Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department

“…LUS predicts mortality with AUC 0.72, and score ≥ 26 had 90% specificity for mortality during admission. Interestingly, two recent studies also demonstrated that LUS has a good agreement in the assessment of outcomes in COVID-19 patients: Brahier et al and Youden et al showed correlation between LUS and mortality with AUC 0.76 and 0.78, respectively [ 20 , 21 ].…”

“…There are a few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19. LUS has been strongly correlated with pulmonary involvement and provides risk stratification, including prediction of need for mechanical ventilation and mortality [ 20 , 21 ].…”

Chest CT Features of 182 Patients with Mild Coronavirus Disease 2019 (COVID-19) Pneumonia: A Longitudinal, Retrospective and Descriptive Study

“…Obviously, CT plays an important role in controlling the spread of COVID-19. However, CT has some insurmountable shortcomings, such as high cost, exposure to radiation, and their immobile nature, which can be overcome by lung ultrasound (LUS) [28][29][30][31]. Coupled with the fact that the lesions of COVID-19 tend to occur in subpleural regions, LUS has been suggested as a potential triage and diagnostic tool for COVID-19 [32].…”

“…Coupled with the fact that the lesions of COVID-19 tend to occur in subpleural regions, LUS has been suggested as a potential triage and diagnostic tool for COVID-19 [32]. The latest research showed that LUS was a promising tool for early risk stratification in COVID-19, which may guide patients' management strategies, as well as resource allocation in case of surge capacity [28,31].…”