Point-of-Care Lung Ultrasound for Detecting Severe Presentations of Coronavirus Disease 2019 in the Emergency Department: A Retrospective Analysis

Favot, Mark; Malik, Adrienne; Rowland, Jonathan; Haber, Brian D.; Ehrman, Robert R.; Harrison, Nick

doi:10.1097/cce.0000000000000176

Cited by 7 publications

(17 citation statements)

References 15 publications

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“…While descriptive studies of lung POCUS findings in COVID-19 are numerous [ 19 , 22 , 25 ], this is most thorough investigation of a quantitative lung POCUS score to diagnose COVID-19 with data allowing maximization of sensitivity, specificity, and discriminative ability. Other studies do provide information on the test characteristics of lung POCUS in the diagnosis of COVID-19, but are limited by much smaller cohorts and unable to demonstrate the performance in populations with various comorbidities [ 26 , 27 , 29 , 31 ]. The present study provides a more comprehensive assessment of the diagnostic power of lung POCUS in a large heterogenous population, and provides vital information for properly applying lung POCUS in the diagnosis of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Brenner

Liu²,

Omron

et al. 2021

Ultrasound J

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Background As medical infrastructures are strained by SARS-CoV-2, rapid and accurate screening tools are essential. In portions of the world, reverse transcription polymerase chain reaction (RT-PCR) testing remains slow and in limited supply, and computed tomography is expensive, inefficient, and involves exposure to ionizing radiation. Multiple studies evaluating the efficiency of lung point-of-care ultrasound (POCUS) have been published recently, but include relatively small cohorts and often focus on characteristics associated with severe illness rather than screening efficacy. This study utilizes a retrospective cohort to evaluate the test characteristics (sensitivity, specificity, likelihood ratios, predictive values) of lung POCUS in the diagnosis of SARS-CoV-2, and to determine lung score cutoffs that maximize performance for use as a screening tool. Results Lung POCUS examinations had sensitivity 86%, specificity 71.6%, NPV 81.7%, and PPV 77.7%. The Lung Ultrasound Score had an area under the curve of 0.84 (95% CI 0.78, 0.90). When including only complete examinations visualizing 12 lung fields, lung POCUS had sensitivity 90.9% and specificity 75.6%, with NPV 87.2% and PPV 82.0% and an area under the curve of 0.89 (95% CI 0.83, 0.96). Lung POCUS was less accurate in patients with a history of interstitial lung disease, severe emphysema, and heart failure. Conclusions When applied in the appropriate patient population, lung POCUS is an inexpensive and reliable tool for rapid screening and diagnosis of SARS-CoV-2 in symptomatic patients with influenza-like illness. Adoption of lung POCUS screening for SARS-CoV-2 may identify patients who do not require additional testing and reduce the need for RT-PCR testing in resource-limited environments and during surge periods.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Brenner

Liu²,

Omron

et al. 2021

Ultrasound J

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“…One retrospective cohort study investigated whether LUS could be used to detect COVID-19 in 42 patients with COVID-19 and 24 controls without COVID-19. In that study, the B-line score had a similar sensitivity to detect COVID-19 than chest X-ray and CT and improved specificity compared to chest radiograph [29]. However, the sample size was quite small, and they did not investigate how LUS findings were associated with the development of VTE.…”

Section: Discussionmentioning

confidence: 93%

“…In addition, 99.5% of the included patients had at least one B-line in one of the LUS zones. Several small cohort studies have investigated the presence of pathological LUS findings in patients with COVID-19 and their relation to computed tomography findings [28,29]. One retrospective cohort study investigated whether LUS could be used to detect COVID-19 in 42 patients with COVID-19 and 24 controls without COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

et al. 2021

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Purpose Several studies have reported thromboembolic events to be common in severe COVID-19 cases. We sought to investigate the relationship between lung ultrasound (LUS) findings in hospitalized COVID-19 patients and the development of venous thromboembolic events (VTE). Methods A total of 203 adults were included from a COVID-19 ward in this prospective multi-center study (mean age 68.6 years, 56.7% men). All patients underwent 8-zone LUS, and all ultrasound images were analyzed off-line blinded. Several LUS findings were investigated (total number of B-lines, B-line score, and LUS-scores). Results Median time from admission to LUS examination was 4 days (IQR: 2, 8). The median number of B-lines was 12 (IQR: 8, 18), and 44 (21.7%) had a positive B-line score. During hospitalization, 17 patients developed VTE (4 deep-vein thrombosis, 15 pulmonary embolism), 12 following and 5 prior to LUS. In fully adjusted multivariable Cox models (excluding participants with VTE prior to LUS), all LUS parameters were significantly associated with VTE (total number of B-lines:

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“… 8 , 14 , 24 , 28 Convex transducers were used in six of the included studies to show lung pathology extent. 8 , 14 , 23 , 27 , 29 , 30 In comparison, two studies used the linear transducer besides the convex transducer to assess plural line thickness and regularity. 17 , 31 However, one study used a convex transducer in 86% and a linear transducer in 14% of the samples.…”

Section: Resultsmentioning

confidence: 99%

“…High risk of bias was demonstrated in the flow and timing domain for the studies reporting more than a 14‐day interval between the RT‐PCR and LUS, and if not all the patients had RT‐PCR test. 23 , 24 …”

Section: Resultsmentioning

confidence: 99%

The diagnostic performance of lung ultrasound for detecting COVID‐19 in emergency departments: A systematic review and meta‐analysis

Jari

Alfuraih

McLaughlan

2022

J of Clinical Ultrasound

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Purpose To perform a systematic review and meta‐analysis of published literature investigating the use of lung ultrasound (LUS) on COVID‐19 patients, in emergency point of care settings, and to determine its diagnostic value compared with lung computed tomography (LCT) diagnostic performance. Whilst using the real‐time polymerase chain reaction test as the ‘gold standard’. Methods Literature searches were performed on MEDLINE, Embase, Web of Science, and PubMed databases for eligible studies. The LUS and LCT pooled diagnostic performance were measured using DerSimonian–Laird random effect method. Result Out of a total of 158 studies, 16 met the eligibility criteria and were included in this review. The pooled sensitivity, specificity, positive and negative likelihood ratios were 86.9%, 62.4%, 2.4 and 0.19, respectively for LUS and 93.5%, 72.6%, 3.3 and 0.05, respectively for LCT. Conclusion The lung ultrasound (LUS) demonstrated acceptable sensitivity but poor specificity when used independently to diagnose COVID‐19 pneumonia patients in emergency departments, while the lung computed tomography showed higher performance. Thus, LUS can be used to supplement existing diagnostic tools and possibly for the triage of patients.

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Point-of-Care Lung Ultrasound for Detecting Severe Presentations of Coronavirus Disease 2019 in the Emergency Department: A Retrospective Analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 7 publications

References 15 publications

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Diagnostic accuracy of lung ultrasound for SARS-CoV-2: a retrospective cohort study

Lung ultrasound findings in hospitalized COVID-19 patients in relation to venous thromboembolic events: the ECHOVID-19 study

The diagnostic performance of lung ultrasound for detecting COVID‐19 in emergency departments: A systematic review and meta‐analysis

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