Lung Ultrasound for COVID-19 Evaluation in the Emergency Department: Is It Feasible?

Wolfshohl, Jon; Shedd, Andrew; Chou, Eric; d'Etienne, James P

doi:10.1016/j.annemergmed.2020.05.033

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…On the other hand, it has variable sensitivity/specificity depending on the setting in which it is used (e.g. the emergency department versus critical care) [32][33][34] and facilities and expertise in this imaging modality are less than they are for CTPA in most UK hospitals, which may prevent more widespread use [35][36].…”

Section: Discussionmentioning

confidence: 99%

Chest pain mimicking pulmonary embolism may be a common presentation of COVID‐19 in ambulant patients without other typical features of infection

et al. 2021

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Background Radiological and pathological studies in severe COVID‐19 pneumonia (SARS‐CoV‐2) have demonstrated extensive pulmonary immunovascular thrombosis and infarction. This study investigated whether these focal changes may present with chest pain mimicking pulmonary emoblism (PE) in ambulant patients. Methods CTPAs from outpatients presenting with chest pain to Leeds Teaching Hospital NHS Trust 1st March to 31 May 2020 ( n = 146) and 2019 ( n = 85) were compared. Regions of focal ground glass opacity (GGO), consolidation and/or atelectasis (parenchymal changes) were determined, and all scans were scored using British Society for Thoracic Imaging (BSTI) criteria for COVID‐19, and the 2020 cohort was offered SARS‐CoV‐2 antibody testing. Results Baseline demographic and clinical data were similar between groups with absence of fever, normal lymphocytes and marginally elevated CRP and D‐Dimer values. Evidence of COVID‐19 or parenchymal changes was observed in 32.9% (48/146) of cases in 2020 compared to 16.5% (14/85) in 2019 ( P = 0.007). 11/146 (7.5%) patients met BSTI criteria for COVID‐19 in 2020 compared with 0/14 in 2019 ( P = 0.008). 3/39 patients tested had detectable COVID‐19 antibodies (2 with parenchymal changes and 1 with normal parenchyma) however 0/6 patients whose CTPA met BSTI criteria “likely/suspicious for COVID‐19” and attended antibody testing were SARS‐CoV‐2 antibody positive. Conclusions 32.8% ambulatory patients with suspected PE in 2020 had parenchymal changes with 7.5% diagnosed as COVID‐19 infection by imaging criteria, despite the absence of other COVID‐19 symptoms. These findings suggest that localized COVID‐19 pneumonitis with immunothrombosis occurs distal to the bronchiolar arteriolar circulation, causing pleural irritation and chest pain without viraemia, accounting for the lack of fever and systemic symptoms.

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Section: Discussionmentioning

confidence: 99%

Chest pain mimicking pulmonary embolism may be a common presentation of COVID‐19 in ambulant patients without other typical features of infection

et al. 2021

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“…In terms of feasibility, Wolfshohl et al [38] conducted a survey on emergency physicians which suggested the majority were not prepared to perform LUS in emergency settings because of lack of targeted training despite their awareness of its superior diagnostic performance. In contrast, Narinx et al [26] reported a more positive experience in their study, which agrees with our experience, in which LUS was a useful, rapid, and safe tool in the ER.…”

Section: Discussionmentioning

confidence: 99%

Lung Ultrasound using a Handheld Device to Diagnose COVID-19 in the Emergency Department

Alfuraih¹,

Alshehri²,

Alshehri³

et al. 2021

DSAHMJ

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The Coronavirus Disease 2019 (COVID-19) pandemic has critically struck healthcare systems and burdened emergency services. To date, there is no accurate and rapid point-of-care diagnostic test. This study aimed to investigate Lung Ultrasound (LUS) against Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test in suspected COVID-19 patients presenting to the emergency department. In 20 eligible patients (mean age ± standard deviation, 49 ± 15 years), 12 had a positive RT-PCR test and undergone an LUS examination over 12 lung zones using a handheld ultrasound device. Each zone was semiquantitatively scored according to the Lung Ultrasound Scoring System (LUSS) from 0 to 3 based on the severity of findings (pleural line irregularity, B-lines, consolidations) and documented the presence of light beam artifacts. A second blinded reader scored the images to investigate interreader reproducibility. The LUSS score had a modest diagnostic performance at 66.6% [95% Confidence Interval (CI), 34.9-90.0%] sensitivity and 75.0% (95% CI, 34.9-96.8%) specificity. The light beam artifact was more prevalent and sensitive to COVID-19 patients with 81.8% (95% CI, 48.2-97.7%) sensitivity and 75.0% (95% CI, 34.9-96.8%) specificity. LUS had an almost perfect interreader reproducibility for LUSS (Kendall's W = 0.961; 95% CI, 0.894-0.985) and light beam artifact (Cohen's κ = 0.890; 95% CI, 0.683-1.00). Overall, LUS using handheld devices can offer a safe, reproducible, rapid, and feasible first-line tool for detecting COVID-19 patients in emergency departments. The light beam artifact was more sensitive and specific to COVID-19 patients and can be useful for effectively triaging suspected cases.

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Elderly Woman With Cough, Fever, and Dyspnea

Frenkel

Barbic

Francispragasm

et al. 2021

Annals of Emergency Medicine

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Lung Ultrasound for COVID-19 Evaluation in the Emergency Department: Is It Feasible?

Cited by 3 publications

References 4 publications

Chest pain mimicking pulmonary embolism may be a common presentation of COVID‐19 in ambulant patients without other typical features of infection

Chest pain mimicking pulmonary embolism may be a common presentation of COVID‐19 in ambulant patients without other typical features of infection

Lung Ultrasound using a Handheld Device to Diagnose COVID-19 in the Emergency Department

Elderly Woman With Cough, Fever, and Dyspnea

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