Canadian Internal Medicine Ultrasound (CIMUS) Expert Consensus Statement on the Use of Lung Ultrasound for the Assessment of Medical Inpatients With Known or Suspected Coronavirus Disease 2019

Abstract

Objectives-To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 .Methods-Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered.Results-Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus.Conclusions-In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.

The Risk of Hospitalization in COVID-19 Patients Can Be Predicted by Lung Ultrasound in Primary Care

“…We also consider that, in the absence of other clinical criteria, the decision for hospital referral should not only be made on the basis of the LUS findings. In this sense, our study is in line with recommendations of Ma et al [ 10 ] on the use of pulmonary point of care ultrasound (POCUS) to evaluate hospitalized patients with known or suspected COVID-19, above all with recommendation 6 [ 10 ].…”

“…The capacity of LUS for early detection of COVID-19 pneumonia was already described in other publications [ 10 , 17 , 23 ]. Here, for the first time in primary care, we show the great relevance of LUS to predict the evolution of COVID-19 pneumonia diagnosed by ultrasound and confirmed by biological tests.…”

“…To date, the scientific community has accepted that LUS is a first-line tool in the early diagnosis of COVID-19 pneumonia [ 10 ]. Some studies assessed the ability of LUS to predict the evolution of the patient [ 11 , 12 , 13 , 14 , 15 , 16 ], however, most of them were carried out in hospital settings; therefore, they did not consider situations prior to hospital admission.…”

Minimal Criteria for Lung Ultrasonography in Internal Medicine

“…However, our experts are true experts of LUS, including a number who participated in national and international consensus statements that did include an extensive literature strategy. 8,11 Lastly, although not every expert answered every question in our survey, only two questions in all three rounds of the survey had missing responses.…”

“…[5][6][7] Its use may also be gaining importance in the assessment of patients with coronavirus-19. 8 Despite it being relatively easy to learn, to support the use of LUS clinically, appropriate training in image acquisition and interpretation is required. It is generally accepted by POCUS experts that images not meeting minimal criteria, such as those that have insufficient depth or inadequate optimization of the pleural line, should not be used to support clinical decision-making, 9 as they may introduce serious diagnostic errors.…”