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Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831)....

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Autores principales: Bima, Paolo, Pivetta, Emanuele, Baricocchi, Denise, Giamello, Jacopo Davide, Risi, Francesca, Vesan, Matteo, Chiarlo, Michela, De Stefano, Giuliano, Ferreri, Enrico, Lauria, Giuseppe, Podio, Stefano, Nazerian, Peiman, Aprà, Franco, Lupia, Enrico, Morello, Fulvio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181775/
https://www.ncbi.nlm.nih.gov/pubmed/35683419
http://dx.doi.org/10.3390/jcm11113032
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author Bima, Paolo
Pivetta, Emanuele
Baricocchi, Denise
Giamello, Jacopo Davide
Risi, Francesca
Vesan, Matteo
Chiarlo, Michela
De Stefano, Giuliano
Ferreri, Enrico
Lauria, Giuseppe
Podio, Stefano
Nazerian, Peiman
Aprà, Franco
Lupia, Enrico
Morello, Fulvio
author_facet Bima, Paolo
Pivetta, Emanuele
Baricocchi, Denise
Giamello, Jacopo Davide
Risi, Francesca
Vesan, Matteo
Chiarlo, Michela
De Stefano, Giuliano
Ferreri, Enrico
Lauria, Giuseppe
Podio, Stefano
Nazerian, Peiman
Aprà, Franco
Lupia, Enrico
Morello, Fulvio
author_sort Bima, Paolo
collection PubMed
description In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68–0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan–Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95–9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8–88.8) and 74% (95%CI 69.5–78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions.
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spelling pubmed-91817752022-06-10 Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department Bima, Paolo Pivetta, Emanuele Baricocchi, Denise Giamello, Jacopo Davide Risi, Francesca Vesan, Matteo Chiarlo, Michela De Stefano, Giuliano Ferreri, Enrico Lauria, Giuseppe Podio, Stefano Nazerian, Peiman Aprà, Franco Lupia, Enrico Morello, Fulvio J Clin Med Article In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68–0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan–Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95–9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8–88.8) and 74% (95%CI 69.5–78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions. MDPI 2022-05-27 /pmc/articles/PMC9181775/ /pubmed/35683419 http://dx.doi.org/10.3390/jcm11113032 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bima, Paolo
Pivetta, Emanuele
Baricocchi, Denise
Giamello, Jacopo Davide
Risi, Francesca
Vesan, Matteo
Chiarlo, Michela
De Stefano, Giuliano
Ferreri, Enrico
Lauria, Giuseppe
Podio, Stefano
Nazerian, Peiman
Aprà, Franco
Lupia, Enrico
Morello, Fulvio
Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
title Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
title_full Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
title_fullStr Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
title_full_unstemmed Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
title_short Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
title_sort lung ultrasound improves outcome prediction over clinical judgment in covid-19 patients evaluated in the emergency department
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181775/
https://www.ncbi.nlm.nih.gov/pubmed/35683419
http://dx.doi.org/10.3390/jcm11113032
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