Effect of Different Probes and Expertise on the Interpretation Reliability of Point-of-Care Lung Ultrasound

Goff, Clotilde Gomond-Le; Vivalda, Laura; Foligno, Silvia; Loi, Barbara; Yousef, Nadya; Luca, Danièle De

doi:10.1016/j.chest.2019.11.013

Cited by 78 publications

(50 citation statements)

References 28 publications

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“…11,22 Others have shown that there is substantial interrater reliability for LUS across differing probes (e.g. linear vs. phased array) 25,26 , which is important given different portable devices were used in this investigation. Future investigations of LUS for COVID-19 should consider multiple observers to confirm less-reliable findings and utilize a standardized interpretation protocol.…”

Section: Discussionmentioning

confidence: 93%

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Kumar

Weng

Graglia

et al. 2020

Preprint

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Background: Lung ultrasound (LUS) may be used in the diagnostic evaluation of patients with COVID-19. An abnormal LUS is associated with increased risk for ICU admission in COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown. Research Question: What is the interrater reliability of lung ultrasound findings in patients with RT-PCR confirmed COVID-19? Study Design and Methods: This study was conducted at conducted at two academic medical centers between 03/2020-06/2020. Nine physicians (hospitalists: n=4; emergency medicine: n=5) independently evaluated n=20 LUS scans (n=180 independent observations) collected from RT-PCR confirmed COVID-19 patients. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values were used to calculate IRR. Results: There was substantial IRR on the following items: normal LUS scan (K=0.79 [95% CI: 0.72-0.87]), presence of B-lines (K=0.79 [95% CI: 0.72-0.87]), >=3 B-lines observed (K=0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (K=0.57 [95% CI: 0.50-0.64]), subpleural consolidation (K=0.49 [95% CI: 0.42-0.56]), and presence of effusion (K=0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (K=0.23 [95% CI: 0.15-0.30]). Interpretation: Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.

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Section: Discussionmentioning

confidence: 93%

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Kumar

Weng

Graglia

et al. 2020

Preprint

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“…Lung ultrasound also has additional interesting characteristics. It may reduce radiation exposure [51], and basic lung ultrasound semiology is successfully recognized with any type of probe and with high agreement between physicians of different expertise [52,53] while the learning curve is steep also in developing countries [54]. Consistently, lung ultrasound has been recently listed amongst the point-of-care ultrasound to be used in paediatric and neonatal critical care whose evidence-based guidelines have been recently released [55].…”

Section: Functional Lung Imaging: Lung Ultrasoundmentioning

confidence: 99%

Personalized Medicine for the Management of RDS in Preterm Neonates

et al. 2021

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Continuous positive airway pressure and surfactant represent the first- and second-line treatment for respiratory distress syndrome in preterm neonates, as European and American guidelines, since 2013 and 2014, respectively, started to recommend surfactant replacement only when continuous positive airway pressure fails. These recommendations, however, are not personalized to the individual physiopathology. Simple clinical algorithms may have improved the diffusion of neonatal care, but complex medical issues can hardly be addressed with simple solutions. The treatment of respiratory distress syndrome is a complex matter and can be only optimized with personalization. We performed a review of tools to individualize the management of respiratory distress syndrome based on physiopathology and actual patients’ need, according to precision medicine principles. Advanced oxygenation metrics, lung ultrasound, electrical impedance tomography, and both quantitative and qualitative surfactant assays were examined. When these techniques were investigated with diagnostic accuracy studies, reliability measures have been meta-analysed. Amongst all these tools, quantitative lung ultrasound seems the more developed for the widespread use and has a higher diagnostic accuracy (meta-analytical AUC = 0.952 [95% CI: 0.951–0.953]). Surfactant adsorption (AUC = 0.840 [95% CI: 0.824–0.856]) and stable microbubble test (AUC = 0.800 [95% CI: 0.788–0.812]) also have good reliability, but need further industrial development. We advocate for a more accurate characterization and a personalized approach of respiratory distress syndrome. With the above-described currently available tools, it should be possible to personalize the treatment of respiratory distress syndrome according to physiopathology.

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“…Such lesions are easily detected in a lung ultrasound (LUS), where B-line artifacts are searched for. However, without considering clinical data, differentiating the etiology of lesions affecting the interstitium is much more difficult [2][3][4][5]. Consequently, searching for further possibilities for differentiating a pulmonary from cardiogenic etiology of interstitial lesions using LUS is well grounded.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of Vertical Artifacts Changing with Frequency in Lung Ultrasound

et al. 2021

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Background: This study concerns the application of lung ultrasound (LUS) for the evaluation of the significance of vertical artifact changes with frequency and pleural line abnormalities in differentiating pulmonary edema from pulmonary fibrosis. Study Design and Methods: The study was designed as a diagnostic test. Having qualified patients for the study, an ultrasound examination was performed, consistent with a predetermined protocol, and employing convex and linear transducers. We investigated the possibility of B-line artifact conversion depending on the set frequency (2 MHz and 6 MHz), and examined pleural line abnormalities. Results: The study group comprised 32 patients with interstitial lung disease (ILD) (and fibrosis) and 30 patients with pulmonary edema. In total, 1941 cineloops were obtained from both groups and analyzed. The employment of both types of transducers (linear and convex) was most effective (specificity 91%, specificity 97%, positive predictive value (PPV) 97%, negative predictive value (NPV) 91%, LR(+) 27,19, LR(−) 0.097, area under curve (AUC) = 0.936, p = 7 × 10−6). Interpretation: The best accuracy in differentiating the etiology of B-line artifacts was obtained with the use of both types of transducers (linear and convex), complemented with the observation of the conversion of B-line artifacts to Z-line.

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Effect of Different Probes and Expertise on the Interpretation Reliability of Point-of-Care Lung Ultrasound

Cited by 78 publications

References 28 publications

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Interobserver Agreement of Lung Ultrasound Findings of COVID-19

Personalized Medicine for the Management of RDS in Preterm Neonates

Clinical Impact of Vertical Artifacts Changing with Frequency in Lung Ultrasound

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