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Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19
INTRODUCTION: Coronavirus disease 2019 (COVID-19) can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) evaluation of symptomatic patients with normal vital signs is frequently limited to chest auscult...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Department of Emergency Medicine, University of California, Irvine School of Medicine
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673866/ https://www.ncbi.nlm.nih.gov/pubmed/33052813 http://dx.doi.org/10.5811/westjem.2020.8.49205 |
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author | Walsh, Paul Hankins, Andrea Bang, Heejung |
author_facet | Walsh, Paul Hankins, Andrea Bang, Heejung |
author_sort | Walsh, Paul |
collection | PubMed |
description | INTRODUCTION: Coronavirus disease 2019 (COVID-19) can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) evaluation of symptomatic patients with normal vital signs is frequently limited to chest auscultation and oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for COVID-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with COVID-19 less than 2% of the time. METHODS: We performed a retrospective, structured, blinded ultrasound review and chart review in patients 14 years or older with symptoms prompting ED evaluation for COVID-19. We excluded those with known congestive heart failure or other chronic lung conditions likely to cause excessive B-lines on LUS. We used a two-sided exact hypothesis test for binomial random variables. We measured LUS diagnostic performance using computed tomography as the gold standard. RESULTS: We reviewed 77 charts; 49 met inclusion criteria. Vital signs were normal in 30/49 patients; 10 (33%) of these patients had LUS consistent with viral pneumonitis. We rejected the null hypothesis (p-value <0.001). The treating physicians’ interpretations of their own point-of-care LUS had a sensitivity of 100% (95% confidence interval (CI), 74%, 100%), specificity 88% (95% CI, 47%, 100%), likelihood ratio (LR) positive of 5.8 (95% CI, 1.3, 25), and LR negative of 0.05 (95% CI, 0.03, 0.71) when compared to CT findings. CONCLUSION: LUS had a meaningful detection rate for pneumonitis in symptomatic ED patients with normal vital signs who were being evaluated for COVID-19. We recommend at least LUS be used in addition to polymerase chain reaction testing when evaluating symptomatic ED patients for COVID-19. |
format | Online Article Text |
id | pubmed-7673866 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Department of Emergency Medicine, University of California, Irvine School of Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-76738662020-11-24 Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 Walsh, Paul Hankins, Andrea Bang, Heejung West J Emerg Med Endemic Infections INTRODUCTION: Coronavirus disease 2019 (COVID-19) can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) evaluation of symptomatic patients with normal vital signs is frequently limited to chest auscultation and oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for COVID-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with COVID-19 less than 2% of the time. METHODS: We performed a retrospective, structured, blinded ultrasound review and chart review in patients 14 years or older with symptoms prompting ED evaluation for COVID-19. We excluded those with known congestive heart failure or other chronic lung conditions likely to cause excessive B-lines on LUS. We used a two-sided exact hypothesis test for binomial random variables. We measured LUS diagnostic performance using computed tomography as the gold standard. RESULTS: We reviewed 77 charts; 49 met inclusion criteria. Vital signs were normal in 30/49 patients; 10 (33%) of these patients had LUS consistent with viral pneumonitis. We rejected the null hypothesis (p-value <0.001). The treating physicians’ interpretations of their own point-of-care LUS had a sensitivity of 100% (95% confidence interval (CI), 74%, 100%), specificity 88% (95% CI, 47%, 100%), likelihood ratio (LR) positive of 5.8 (95% CI, 1.3, 25), and LR negative of 0.05 (95% CI, 0.03, 0.71) when compared to CT findings. CONCLUSION: LUS had a meaningful detection rate for pneumonitis in symptomatic ED patients with normal vital signs who were being evaluated for COVID-19. We recommend at least LUS be used in addition to polymerase chain reaction testing when evaluating symptomatic ED patients for COVID-19. Department of Emergency Medicine, University of California, Irvine School of Medicine 2020-11 2020-09-28 /pmc/articles/PMC7673866/ /pubmed/33052813 http://dx.doi.org/10.5811/westjem.2020.8.49205 Text en Copyright: © 2020 Walsh et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Endemic Infections Walsh, Paul Hankins, Andrea Bang, Heejung Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 |
title | Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 |
title_full | Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 |
title_fullStr | Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 |
title_full_unstemmed | Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 |
title_short | Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19 |
title_sort | point-of-care lung ultrasound is useful to evaluate emergency department patients for covid-19 |
topic | Endemic Infections |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673866/ https://www.ncbi.nlm.nih.gov/pubmed/33052813 http://dx.doi.org/10.5811/westjem.2020.8.49205 |
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