Cargando…

Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department

BACKGROUND: Bedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy. DESIGN: A multicentre, prospective, o...

Descripción completa

Detalles Bibliográficos
Autores principales: Kok, Bram, Schuit, Frederik, Lieveld, Arthur, Azijli, Kaoutar, Nanayakkara, Prabath WB, Bosch, Frank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8449840/
https://www.ncbi.nlm.nih.gov/pubmed/34531211
http://dx.doi.org/10.1136/bmjopen-2021-048795
_version_ 1784569498030833664
author Kok, Bram
Schuit, Frederik
Lieveld, Arthur
Azijli, Kaoutar
Nanayakkara, Prabath WB
Bosch, Frank
author_facet Kok, Bram
Schuit, Frederik
Lieveld, Arthur
Azijli, Kaoutar
Nanayakkara, Prabath WB
Bosch, Frank
author_sort Kok, Bram
collection PubMed
description BACKGROUND: Bedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy. DESIGN: A multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED. SETTING/PATIENTS: Adult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR. MEASUREMENTS: We assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard. RESULTS: Between 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16. CONCLUSION: Identifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement. TRIAL REGISTRATION NUMBER: NL8497.
format Online
Article
Text
id pubmed-8449840
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-84498402021-09-20 Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department Kok, Bram Schuit, Frederik Lieveld, Arthur Azijli, Kaoutar Nanayakkara, Prabath WB Bosch, Frank BMJ Open Radiology and Imaging BACKGROUND: Bedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy. DESIGN: A multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED. SETTING/PATIENTS: Adult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR. MEASUREMENTS: We assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard. RESULTS: Between 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16. CONCLUSION: Identifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement. TRIAL REGISTRATION NUMBER: NL8497. BMJ Publishing Group 2021-09-16 /pmc/articles/PMC8449840/ /pubmed/34531211 http://dx.doi.org/10.1136/bmjopen-2021-048795 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Radiology and Imaging
Kok, Bram
Schuit, Frederik
Lieveld, Arthur
Azijli, Kaoutar
Nanayakkara, Prabath WB
Bosch, Frank
Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department
title Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department
title_full Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department
title_fullStr Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department
title_full_unstemmed Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department
title_short Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department
title_sort comparing lung ultrasound: extensive versus short in covid-19 (clues): a multicentre, observational study at the emergency department
topic Radiology and Imaging
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8449840/
https://www.ncbi.nlm.nih.gov/pubmed/34531211
http://dx.doi.org/10.1136/bmjopen-2021-048795
work_keys_str_mv AT kokbram comparinglungultrasoundextensiveversusshortincovid19cluesamulticentreobservationalstudyattheemergencydepartment
AT schuitfrederik comparinglungultrasoundextensiveversusshortincovid19cluesamulticentreobservationalstudyattheemergencydepartment
AT lieveldarthur comparinglungultrasoundextensiveversusshortincovid19cluesamulticentreobservationalstudyattheemergencydepartment
AT azijlikaoutar comparinglungultrasoundextensiveversusshortincovid19cluesamulticentreobservationalstudyattheemergencydepartment
AT nanayakkaraprabathwb comparinglungultrasoundextensiveversusshortincovid19cluesamulticentreobservationalstudyattheemergencydepartment
AT boschfrank comparinglungultrasoundextensiveversusshortincovid19cluesamulticentreobservationalstudyattheemergencydepartment