Chest ultrasound in Italian geriatric wards: use, applications and clinicians’ attitudes

Ticinesi, Andrea; Lauretani, Fulvio; Nouvenne, Antonio; Ungar, Andrea; Incalzi, Raffaele Antonelli; Scarlata, Simone

doi:10.36150/2499-6564-337

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…Unfortunately, point-of-care ultrasonography is not widespread in geriatric practice, and training programs are urgently needed to fill this gap. 26 In older nursing home residents, timing of COVID-19 diagnosis may be crucial for reducing adverse outcomes. From this perspective, the use of point-of-care ultrasonography could provide a relevant diagnostic aid for improving patient care and outcomes.…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

Nouvenne

Ticinesi

Parise

et al. 2020

Journal of the American Medical Directors Association

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Objective: Bedside chest ultrasonography, when integrated with clinical data, is an accurate tool for improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasonographic screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)erelated pneumonia and improving the appropriateness of hospital referral of residents. Design: Pragmatic, descriptive, feasibility study from April 2 to April 9, 2020. Setting and Participants: A total of 83 older residents (age 85 AE 8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in 5 nursing homes in Northern Italy. Methods: Chest ultrasonography was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring 4 different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations, and pleural line indentation, was detected. The specialist team integrated ultrasonography data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed. Results: The most frequent reasons for ultrasonographic evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasonographic findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and 6 of them required hospitalization. Twelve patients had ultrasonographic patterns suggesting other respiratory diseases, and 2 patients with normal ultrasonographic findings were diagnosed with COPD exacerbation. Conclusions and Implications: In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.Ó 2020 AMDA e The Society for Post-Acute and Long-Term Care Medicine.Coronavirus disease 2019 (COVID-19) represents a big challenge for geriatric medicine. 1,2 Frail older people are particularly at risk for developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3,4 and their clinical course is often characterized byThe authors declare no conflicts of interest.

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Section: Discussionmentioning

confidence: 99%

Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

Nouvenne

Ticinesi

Parise

et al. 2020

Journal of the American Medical Directors Association

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Advancing healthcare through thoracic ultrasound research in older patients

Scarlata,

Okoye,

Zotti

et al. 2023

Aging Clin Exp Res

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This paper reports the proceedings of a meeting convened by the Research Group on Thoracic Ultrasound in Older People of the Italian Society of Gerontology and Geriatrics, to discuss the current state-of-the-art of clinical research in the field of geriatric thoracic ultrasound and identify unmet research needs and potential areas of development. In the last decade, point-of-care thoracic ultrasound has entered clinical practice for diagnosis and management of several respiratory illnesses, such as bacterial and viral pneumonia, pleural effusion, acute heart failure, and pneumothorax, especially in the emergency–urgency setting. Very few studies, however, have been specifically focused on older patients with frailty and multi-morbidity, who frequently exhibit complex clinical pictures needing multidimensional evaluation. At the present state of knowledge, there is still uncertainty on the best requirements of ultrasound equipment, methodology of examination, and reporting needed to optimize the advantages of thoracic ultrasound implementation in the care of geriatric patients. Other issues regard differential diagnosis between bacterial and aspiration pneumonia, objective grading of interstitial syndrome severity, quantification and monitoring of pleural effusions and solid pleural lesions, significance of ultrasonographic assessment of post-COVID-19 sequelae, and prognostic value of assessment of diaphragmatic thickness and motility. Finally, application of remote ultrasound diagnostics in the community and nursing home setting is still poorly investigated by the current literature. Overall, the presence of several open questions on geriatric applications of thoracic ultrasound represents a strong call to implement clinical research in this field.

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Chest ultrasound in Italian geriatric wards: use, applications and clinicians’ attitudes

Abstract: Geriatricians' attitude towards chest ultrasound is generally cautious. Research and training programs are needed to spread the correct use of this technique in geriatric practice.

Cited by 2 publications

References 36 publications

Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

Advancing healthcare through thoracic ultrasound research in older patients

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