Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19

INTRODUCTION: Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternati...

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Detalles Bibliográficos
Autores principales: Pare, Joseph R., Camelo, Ingrid, Mayo, Kelly C., Leo, Megan M., Dugas, Julianne N., Nelson, Kerrie P., Baker, William E., Shareef, Faizah, Mitchell, Patricia M., Schechter-Perkins, Elissa M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2020
Materias:
Endemic Infections
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390587/
https://www.ncbi.nlm.nih.gov/pubmed/32726240
http://dx.doi.org/10.5811/westjem.2020.5.47743
Descripción
Sumario:INTRODUCTION: Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR. METHODS: This was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as part of their diagnostic evaluation. The primary objective was to estimate the test characteristics of both LUS B-lines and CXR for the associated diagnosis of COVID-19. Our secondary objective was to evaluate the proportion of patients with COVID-19 that have secondary LUS findings of pleural abnormalities and subpleural consolidations. RESULTS: We identified 43 patients who underwent both LUS and CXR and were tested for COVID-19. Of these, 27/43 (63%) tested positive. LUS was more sensitive (88.9%, 95% confidence interval (CI), 71.1–97.0) for the associated diagnosis of COVID-19 than CXR (51.9%, 95% CI, 34.0–69.3; p = 0.013). LUS and CXR specificity were 56.3% (95% CI, 33.2–76.9) and 75.0% (95% CI, 50.0–90.3), respectively (p = 0.453). Secondary LUS findings of patients with COVID-19 demonstrated 21/27 (77.8%) had pleural abnormalities and 10/27 (37%) had subpleural consolidations. CONCLUSION: Among patients who underwent LUS and CXR, LUS was found to have a higher sensitivity than CXR for the evaluation of COVID-19. This data could have important implications as an aid in the diagnostic evaluation of COVID-19, particularly where viral testing is not available or restricted. If generalizable, future directions would include defining how to incorporate LUS into clinical management and its role in screening lower-risk populations.

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