Cargando…
Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study
BACKGROUND: Assessing the extent of lung involvement is important for the triage and care of COVID‐19 pneumonia. We sought to determine the utility of point‐of‐care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID‐19 pneumonia. METHODS: This m...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087918/ https://www.ncbi.nlm.nih.gov/pubmed/33969350 http://dx.doi.org/10.1002/emp2.12429 |
_version_ | 1783686754045263872 |
---|---|
author | Lieveld, Arthur W. E. Kok, Bram Azijli, Kaoutar Schuit, Frederik H. van de Ven, Peter M. de Korte, Chris L. Nijveldt, Robin van den Heuvel, Frederik M. A. Teunissen, Bernd P. Hoefsloot, Wouter Nanayakkara, Prabath W. B. Bosch, Frank H. |
author_facet | Lieveld, Arthur W. E. Kok, Bram Azijli, Kaoutar Schuit, Frederik H. van de Ven, Peter M. de Korte, Chris L. Nijveldt, Robin van den Heuvel, Frederik M. A. Teunissen, Bernd P. Hoefsloot, Wouter Nanayakkara, Prabath W. B. Bosch, Frank H. |
author_sort | Lieveld, Arthur W. E. |
collection | PubMed |
description | BACKGROUND: Assessing the extent of lung involvement is important for the triage and care of COVID‐19 pneumonia. We sought to determine the utility of point‐of‐care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID‐19 pneumonia. METHODS: This multicenter, prospective, observational study included patients with COVID‐19 who received 12‐zone lung ultrasound and chest computed tomography (CT) scanning in the emergency department (ED). We defined lung disease severity using the lung ultrasound score (LUS) and chest CT severity score (CTSS). We assessed the association between the LUS and poor outcome (ICU admission or 30‐day all‐cause mortality). We also assessed the association between the LUS and hospital length of stay. We examined the ability of the LUS to differentiate between disease severity groups. Lastly, we estimated the correlation between the LUS and CTSS and the interrater agreement for the LUS. We handled missing data by multiple imputation with chained equations and predictive mean matching. RESULTS: We included 114 patients treated between March 19, 2020, and May 4, 2020. An LUS ≥12 was associated with a poor outcome within 30 days (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.26–24.80; P = 0.02). Admission duration was shorter in patients with an LUS <12 (adjusted HR, 2.24; 95% CI, 1.47–3.40; P < 0.001). Mean LUS differed between disease severity groups: no admission, 6.3 (standard deviation [SD], 4.4); hospital/ward, 13.1 (SD, 6.4); and ICU, 18.0 (SD, 5.0). The LUS was able to discriminate between ED discharge and hospital admission excellently, with an area under the curve of 0.83 (95% CI, 0.75–0.91). Interrater agreement for the LUS was strong: κ = 0.88 (95% CI, 0.77–0.95). Correlation between the LUS and CTSS was strong: κ = 0.60 (95% CI, 0.48–0.71). CONCLUSIONS: We showed that baseline lung ultrasound ‐ is associated with poor outcomes, admission duration, and disease severity. The LUS also correlates well with CTSS. Point‐of‐care lung ultrasound may aid the risk stratification and triage of patients with COVID‐19 at the ED. |
format | Online Article Text |
id | pubmed-8087918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-80879182021-05-07 Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study Lieveld, Arthur W. E. Kok, Bram Azijli, Kaoutar Schuit, Frederik H. van de Ven, Peter M. de Korte, Chris L. Nijveldt, Robin van den Heuvel, Frederik M. A. Teunissen, Bernd P. Hoefsloot, Wouter Nanayakkara, Prabath W. B. Bosch, Frank H. J Am Coll Emerg Physicians Open Infectious Disease BACKGROUND: Assessing the extent of lung involvement is important for the triage and care of COVID‐19 pneumonia. We sought to determine the utility of point‐of‐care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID‐19 pneumonia. METHODS: This multicenter, prospective, observational study included patients with COVID‐19 who received 12‐zone lung ultrasound and chest computed tomography (CT) scanning in the emergency department (ED). We defined lung disease severity using the lung ultrasound score (LUS) and chest CT severity score (CTSS). We assessed the association between the LUS and poor outcome (ICU admission or 30‐day all‐cause mortality). We also assessed the association between the LUS and hospital length of stay. We examined the ability of the LUS to differentiate between disease severity groups. Lastly, we estimated the correlation between the LUS and CTSS and the interrater agreement for the LUS. We handled missing data by multiple imputation with chained equations and predictive mean matching. RESULTS: We included 114 patients treated between March 19, 2020, and May 4, 2020. An LUS ≥12 was associated with a poor outcome within 30 days (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.26–24.80; P = 0.02). Admission duration was shorter in patients with an LUS <12 (adjusted HR, 2.24; 95% CI, 1.47–3.40; P < 0.001). Mean LUS differed between disease severity groups: no admission, 6.3 (standard deviation [SD], 4.4); hospital/ward, 13.1 (SD, 6.4); and ICU, 18.0 (SD, 5.0). The LUS was able to discriminate between ED discharge and hospital admission excellently, with an area under the curve of 0.83 (95% CI, 0.75–0.91). Interrater agreement for the LUS was strong: κ = 0.88 (95% CI, 0.77–0.95). Correlation between the LUS and CTSS was strong: κ = 0.60 (95% CI, 0.48–0.71). CONCLUSIONS: We showed that baseline lung ultrasound ‐ is associated with poor outcomes, admission duration, and disease severity. The LUS also correlates well with CTSS. Point‐of‐care lung ultrasound may aid the risk stratification and triage of patients with COVID‐19 at the ED. John Wiley and Sons Inc. 2021-05-01 /pmc/articles/PMC8087918/ /pubmed/33969350 http://dx.doi.org/10.1002/emp2.12429 Text en © 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Infectious Disease Lieveld, Arthur W. E. Kok, Bram Azijli, Kaoutar Schuit, Frederik H. van de Ven, Peter M. de Korte, Chris L. Nijveldt, Robin van den Heuvel, Frederik M. A. Teunissen, Bernd P. Hoefsloot, Wouter Nanayakkara, Prabath W. B. Bosch, Frank H. Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study |
title | Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study |
title_full | Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study |
title_fullStr | Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study |
title_full_unstemmed | Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study |
title_short | Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study |
title_sort | assessing covid‐19 pneumonia—clinical extension and risk with point‐of‐care ultrasound: a multicenter, prospective, observational study |
topic | Infectious Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087918/ https://www.ncbi.nlm.nih.gov/pubmed/33969350 http://dx.doi.org/10.1002/emp2.12429 |
work_keys_str_mv | AT lieveldarthurwe assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT kokbram assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT azijlikaoutar assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT schuitfrederikh assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT vandevenpeterm assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT dekortechrisl assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT nijveldtrobin assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT vandenheuvelfrederikma assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT teunissenberndp assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT hoefslootwouter assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT nanayakkaraprabathwb assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy AT boschfrankh assessingcovid19pneumoniaclinicalextensionandriskwithpointofcareultrasoundamulticenterprospectiveobservationalstudy |