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

Abstract

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.

The value of lung ultrasound in COVID-19 pneumonia, verified by high resolution computed tomography assessed by artificial intelligence

“…Also other previous studies reported that diagnostic agreement between LUS and CT in the assessment of COVID-19 pneumonia is high, however in majority of them CT was not performed using a dedicated HRCT protocol for precise pulmonary tissue assessment [24]. Evidence accumulated through two years of pandemic showed good sensitivity of LUS in detecting COVID-19 pneumonia but poor specificity, which was significantly lower in comparison to HRCT [2].…”

“…For monitoring of disease progression LUS can be done repetitively without exposing the patient to ionizing radiation. LUS is also associated with significantly lower risk of COVID-19 and other infectious transmission as particular devices may be dedicated exclusively to infected patients and the sterilization is simple [2]. Moreover as the ultrasound devices are easily portable, LUS can be performed in critically ill and unstable patient [3].…”

Comparison of lung ultrasound scoring systems for the prognosis of COVID‐19 in the emergency department: An international prospective cohort study

“…13,14 Unfortunately, the diagnostic utility of LUS for COVID-19 has been limited by non-specific findings, which overlap with other viral respiratory infections. 5,15 The LUS scores for the stratification of COVID-19 severity have been devised, which incorporate the main elements of lung findings (B-lines, subpleural consolidation and lung hepatisation) and pleural findings (absence of lung sliding, pleural line abnormalities and pleural effusions). [6][7][8][9] These LUS scores have been used to stratify the severity of disease, to assist with disposition and prognostication.…”

“…2,3 In particular, the utility of lung ultrasound (LUS) for the diagnosis and prognosis of COVID-19 pneumonia for patients presenting to the ED has been explored. 4,5 However, while the LUS scores have been developed for assessing the severity of COVID-19, [6][7][8][9] there have not been any comparative studies for their prognostic value on an international cohort of patients.…”

Reply

“…LUS can have a paper as an ancillary test. 4 It's added benefit in CXR negative patients is nowadays questionable given Omicrons’ generally benign course and the reduction of complications associated to vaccination making them unlikely in general population. Nonetheless, we agree it can have a role in selected patients with CXR contraindications with risk factors for complications, or when CXR is not diagnostic and there is a strong suspicion for COVID-19-related pneumonia.…”