Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department

Pivetta, Emanuele; Goffi, Alberto; Tizzani, Maria; Locatelli, Stefania; Porrino, Giulio; Losano, Isabel; Leone, Dario; Calzolari, G; Vesan, Matteo; Steri, Fabio; Ardito, Arianna; Capuano, Marialessia; Gelardi, Maria; Silvestri, Giulia; Dutto, S.; Avolio, Maria; Cavallo, Rossana; Bartalucci, Alessia; Paglieri, Cristina; Morello, Fulvio; Richiardi, Lorenzo; Maule, Milena; Lupia, Enrico; Baldassa, Federico; Baron, Paolo; Bianchi, Giordano; Busso,; Conterno, Andrea; Rizzo, Paola; Pecetto, Paolo Fascio; Giachino, Francesca; Iannaccone, Andrea; Ferrera, Patrizia; Riccardini, Franco; Sacchi, Claudia; Sozzi, Michela; Totaro, Silvia; Visconti, Pasqualina; Risi, Francesca; F, Basile; Baricocchi, Denise; Beux, Alessia; Beux, Valentina; Bima, Paolo; Cara, Irene; Chichizola, Liliana; Dellavalle, Francesca; Grosso, Federico Vilaplana; Labarile, Giulia; Oddi, Matteo; Ottino, Marco; Pia, Ilaria; Scategni, Virginia; Surra, Astrid

doi:10.1016/j.annemergmed.2020.10.008

Cited by 54 publications

(70 citation statements)

References 31 publications

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“…Several studies have been published on the use of lung ultrasound for the COVID-19 diagnosis; however, most of them were carried out at hospitals and not primary care facilities [ 23 , 24 , 25 , 26 , 27 , 28 ]. Here, it was highlighted lung ultrasound usefulness in primary care for diagnosing patients in an early phase of COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

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Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia

Redondo

Rodríguez

Salud

et al. 2021

IJERPH

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Background: The COVID-19 pandemic rapidly strained healthcare systems worldwide. The reference standard for diagnosis is a positive reverse transcription polymerase chain reaction (RT-PCR) test, but results are not immediate and sensibility is variable. Aim: To evaluate the diagnostic accuracy of lung ultrasound compared to chest X-ray for COVID-19 pneumonia. Design and Setting: A retrospective analysis of symptomatic patients admitted into one primary care centre in Spain between March and September 2020. Method: Patients’ chest X-rays and lung ultrasounds were categorized as normal or pathologic. RT-PCR confirmed COVID-19 infection. Pathologic lung ultrasound images were further categorized as showing either local or diffuse interstitial disease. McNemar and Fisher tests were used to compare diagnostic accuracy. Results: Most of the 212 patients presented fever at admission, either as a standalone symptom (37.74% of patients) or together with others (72.17% of patients). The positive predictive value of the lung ultrasound was 90% for the diffuse interstitial pattern and 46.92% for local pattern. The lung ultrasound had a significantly higher sensitivity (82.75%) (p < 0.001), but lower specificity (71%) than the chest X-ray (54.02% and 86%, respectively) (p = 0.008) for identifying interstitial lung disease. Moreover, sensitivity of the lung ultrasound for severe interstitial disease was 100%, and was significantly higher than the chest X-ray (58.33%) (p = 0.002). Conclusion: The lung ultrasound is more accurate than the chest X-ray for identifying patients with COVID-19 pneumonia and it is especially useful for those presenting diffuse interstitial disease.

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Section: Discussionmentioning

confidence: 99%

“…This was also found in Spain after GPs underwent specific training [ 22 ]. Several studies have reported lung ultrasound is a valuable diagnostic tool for COVID-19 pneumonia; however these were carried out in the hospital setting, most commonly in emergency room or intensive care units [ 23 , 24 , 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia

Redondo

Rodríguez

Salud

et al. 2021

IJERPH

View full text Add to dashboard Cite

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“…The recommendation to limit the use of CT studies in the time of a pandemic surge is also supported by societal guidelines [4,5]. Lung ultrasound (LUS) and chest radiography (CXR) are valid alternatives to be applied in the frontline [1,[6][7][8][9][10][11][12][13][14]. Particularly, LUS demonstrated highly feasible and sensitive for COVID-19 pneumonia, with a specificity that increases during the peaks of prevalence [15].…”

Section: Introductionmentioning

confidence: 99%

Descriptive analysis of a comparison between lung ultrasound and chest radiography in patients suspected of COVID-19

et al. 2021

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Background Lung ultrasound (LUS) and chest radiography (CXR) are the most used chest imaging tools in the early diagnosis of COVID-19 associated pneumonia. However, the relationship between LUS and CXR is not clearly defined. The aim of our study was to describe the comparison between LUS interpretation and CXR readings in the first approach to patients suspected of COVID-19. Methods In the time of the first COVID-19 pandemic surge, we prospectively evaluated adult patients presenting to an emergency department complaining of symptoms raising suspicion of COVID-19. Patients were studied by LUS and only those performing also CXR were analyzed. All the patients performed viral reverse transcriptase-polymerase chain reaction (RT-PCR). LUS studies were classified in 4 categories of probabilities, based on the presence of typical or alternative signs of COVID-19-associated interstitial pneumonia. Accordingly, the CXR readings were retrospectively adapted by 2 experts in 4 categories following the standard language that describes the computed tomography (CT) findings. Patients were divided in two groups, based on the agreement of the LUS and CXR categories. Results were also compared to RT-PCR and, when available, to CT studies. Results We analyzed 139 cases (55 women, mean age 59.1 ± 15.5 years old). The LUS vs CXR results disagreed in 60 (43.2%) cases. RT-PCR was positive in 88 (63.3%) cases. In 45 cases, a CT scan was also performed and only 4 disagreed with LUS interpretation versus 24 in the comparison between CT and CXR. In 18 cases, LUS detected signs of COVID-19 pneumonia (high and intermediate probabilities) while CXR reading was negative; in 14 of these cases, a CT scan or a RT-PCR-positive result confirmed the LUS interpretation. In 6 cases, LUS detected signs of alternative diagnoses to COVID-19 pneumonia while CXR was negative; in 4 of these cases, CT scan confirmed atypical findings. Conclusion Our study demonstrated a strong disagreement between LUS interpretation and CXR reading in the early approach to patients suspected of COVID-19. Comparison with CT studies and RT-PCR results seems to confirm the superiority of LUS over a second retrospective reading of CXR.

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“…COVID-19 has a triphasic course: the early disease (I), the pulmonary (IIa without and IIb with hypoxia) and the hyperin ammation phases [12]. With the ambulatorial strategy, we tried to revaluate patients between stage IIa and IIb.…”

Section: Discussionmentioning

confidence: 99%

Discharge from the Emergency Department and Early Hospital Revaluation in Patients with COVID-19 Pneumonia: an Observational Study

Mattioli

Benfaremo

Fulgenzi

et al. 2021

Preprint

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Background Health National Systems world-wide are facing the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We purpose an outpatient management for patients affected by SARS-CoV-2 related pneumonia at risk of progression, after discharge from Emergency Department (ED).Methods This was a single-center prospective observational study. We enrolled patients with confirmed SARS-CoV-2 pneumonia, without hypoxemic respiratory failure, and at least one of the following: age ≥ 65 or presence of one or more comorbidities or pneumonia involvement > 25% on high resolution computed tomography (HRCT). The ambulatorial visit was performed after at least 48 hours, then patients could be discharged, admitted for hospitalization, or deferred for a further visit. As a control, we evaluated a historical cohort of patients hospitalized with comparable clinical and radiological features.Results A total of 84 patients were enrolled (51 M, mean age 62.8 y). Two-thirds of patients had at least one comorbidity and 41.6% had a lung involvement > 25% at HRCT; the mean duration of symptoms was 8 ± 3 days and the mean PaO2/FiO2 ratio 357.5 ± 38.6. At the end of the follow-up period, 69 patients had been discharged and 15 hospitalized (mean stay 6 days). Older age and higher NEWS2 were significant predictors of hospitalization at the first follow-up visit. One hospitalized patient died of septic shock. In the control group, the mean hospital stay was 8 days.Conclusions Adopting a “discharge and early revaluation” strategy appear to be safe and feasible. This approach may help to optimize hospital resources during the SARS-CoV-2 pandemic.

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Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department

Cited by 54 publications

References 31 publications

Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia

Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia

Descriptive analysis of a comparison between lung ultrasound and chest radiography in patients suspected of COVID-19

Discharge from the Emergency Department and Early Hospital Revaluation in Patients with COVID-19 Pneumonia: an Observational Study

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