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

Abstract

Background During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068). Results The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 ± 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 ± 6.7 vs. 21 ± 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001). Conclusions In COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.

Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

“…This is surprising because several studies have shown that changes in these parameters are associated with higher severity of illness [ 13 – 15 ]. Other studies demonstrated that higher LU scores are associated with an increased disease severity [ 11 , 16 , 17 ]. The lack of relation might be explained by the differences in the studied cohorts.…”

Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review

“…In one study, lung ultrasound was able to detect COVID-19 patients who would benefit from tracheal intubation. 115 Another score to predict failure of non-invasive respiratory strategies has been developed 116 and externally validated. The score includes age, number of comorbidities, respiratory rate-oxygenation index (ROX), GCS, and use of vasopressors on the first day of non-invasive respiratory support as independent predictors of failure.…”

The Risk of Hospitalization in COVID-19 Patients Can Be Predicted by Lung Ultrasound in Primary Care

“…Several studies investigated the prognostic value of ultrasound findings in patients with COVID-19 pneumonia; however, most of them were carried out in patients admitted to hospitals and, therefore, in a more advanced stage of the disease [ 11 , 12 , 13 , 14 , 15 , 16 ]. Many of these studies used pleural abnormalities or the presence of condensations to categorize the risk of deterioration.…”

“…To date, the scientific community has accepted that LUS is a first-line tool in the early diagnosis of COVID-19 pneumonia [ 10 ]. Some studies assessed the ability of LUS to predict the evolution of the patient [ 11 , 12 , 13 , 14 , 15 , 16 ], however, most of them were carried out in hospital settings; therefore, they did not consider situations prior to hospital admission. Few studies addressed the use of LUS in primary health care (PHC) [ 17 , 18 ].…”