Lung ultrasonography in a woman with COVID-19: This examination could be remote

Kirkpatrick, Andrew W.; McKee, Jessica

doi:10.1503/cmaj.75302

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…[17,19] It has even been shown that it can be accurately performed by non-physicians who are guided remotely, so patients could be screened extramurally. [36] LUS has a steep learning curve, for physicians and other (para)medical personnel. The basics can be learned in under two hours.…”

Section: Strengthsmentioning

confidence: 99%

Diagnosing COVID-19 pneumonia in a pandemic setting: Lung UltrasoundversusCT (LUVCT) – a multicentre, prospective, observational study

et al. 2020

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BackgroundIn this COVID-19 pandemic, fast and accurate testing is needed to profile patients at the emergency department (ED) and efficiently allocate resources. Chest imaging has been considered in COVID-19 workup, but evidence on lung ultrasound (LUS) is sparse. We therefore aimed to assess and compare the diagnostic accuracy of LUS and computed tomography (CT) in suspected COVID-19 patients.MethodsThis multi-centre, prospective, observational study included adult patients with suspected COVID-19 referred to internal medicine at the ED. We calculated diagnostic accuracy measures for LUS and CT using both PCR and multi-disciplinary team (MDT) diagnosis as reference. We also assessed agreement between LUS and CT, and between sonographers.ResultsBetween March 19 and May 4, 2020, 187 patients were included. Area under the receiver operating characteristic (AUROC) was 0.81 (CI 0.75–0.88) for LUS and 0.89 (CI 0.84–0.94) for CT. Sensitivity and specificity for LUS were 91.9% (CI 84.0–96.7) and 71.0% (CI 61.1–79.6), versus 88.4% (CI 79.7–94.3) and 82.0% (CI 73.1–89.0) for CT. Negative likelihood ratio was 0.1 (CI 0.06–0.24) for LUS and 0.14 (0.08–0.3) for CT. No patient with a false negative LUS, required supplemental oxygen or admission. LUS specificity increased to 80% (CI 69.9–87.9) compared to MDT diagnosis, with an AUROC of 0.85 (CI 0.79–0.91). Agreement between LUS and CT was 0.65. Inter-observer agreement for LUS was good: 0.89 (CI 0.83–0.93).ConclusionLUS and CT have comparable diagnostic accuracy for COVID-19 pneumonia. LUS can safely exclude clinically relevant COVID-19 pneumonia and may aid COVID-19 diagnosis in high prevalence situations.

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Section: Strengthsmentioning

confidence: 99%

Diagnosing COVID-19 pneumonia in a pandemic setting: Lung UltrasoundversusCT (LUVCT) – a multicentre, prospective, observational study

et al. 2020

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“…An International Panel of Experts recently recommended using tele-ultrasound for remote guidance and consultations in COVID-19 [ 10 ]. We fully agree, and further believe that lung ultrasound examinations can be provided to willing self-isolating infected and at-risk patients using informatic technologies to facilitate self-lung ultrasound surveillance [ 3 , 11 ].…”

Section: Introductionmentioning

confidence: 92%

Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

2021

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COVID-19 has impacted human life globally and threatens to overwhelm health-care resources. Infection rates are rapidly rising almost everywhere, and new approaches are required to both prevent transmission, but to also monitor and rescue infected and at-risk patients from severe complications. Point-of-care lung ultrasound has received intense attention as a cost-effective technology that can aid early diagnosis, triage, and longitudinal follow-up of lung health. Detecting pleural abnormalities in previously healthy lungs reveal the beginning of lung inflammation eventually requiring mechanical ventilation with sensitivities superior to chest radiographs or oxygen saturation monitoring. Using a paradigm first developed for space-medicine known as Remotely Telementored Self-Performed Ultrasound (RTSPUS), motivated patients with portable smartphone support ultrasound probes can be guided completely remotely by a remote lung imaging expert to longitudinally follow the health of their own lungs. Ultrasound probes can be couriered or even delivered by drone and can be easily sterilized or dedicated to one or a commonly exposed cohort of individuals. Using medical outreach supported by remote vital signs monitoring and lung ultrasound health surveillance would allow clinicians to follow and virtually lay hands upon many at-risk paucisymptomatic patients. Our initial experiences with such patients are presented, and we believe present a paradigm for an evolution in rich home-monitoring of the many patients expected to become infected and who threaten to overwhelm resources if they must all be assessed in person by at-risk care providers.

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“…Early on in the pandemic, physicians in an overwhelmed Northern Italian hospital pleaded with the world to adopt increased telemedical surveillance of self-isolating at risk patients to keep them out of the hospital as a means of preserving resources and saving lives [ 48 ]. TMUSMI strongly concurred with this sentiment and proposed that lung RTMSPUS could potentially be performed by willing patients to assess their own lung health remotely and to detect early changes that might prompt the need for earlier in-hospital assessment [ 9 , 34 , 49 ].…”

Section: Remote Telementored Self-performed Ultrasound (Rtmspus) As M...mentioning

confidence: 99%

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care

Kirkpatrick

McKee²,

Couperus³

et al. 2022

Diagnostics

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Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.

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Lung ultrasonography in a woman with COVID-19: This examination could be remote

Cited by 5 publications

References 5 publications

Diagnosing COVID-19 pneumonia in a pandemic setting: Lung UltrasoundversusCT (LUVCT) – a multicentre, prospective, observational study

Diagnosing COVID-19 pneumonia in a pandemic setting: Lung UltrasoundversusCT (LUVCT) – a multicentre, prospective, observational study

Longitudinal remotely mentored self-performed lung ultrasound surveillance of paucisymptomatic Covid-19 patients at risk of disease progression

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care

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