Role of lung ultrasonography in the diagnosis of COVID-19 patients admitted to the emergency department

Abstract

Introduction In this study, the use of lung ultrasonography (LUS) to diagnosis lung findings was evaluated in patients with suspected COVID-19 who were admitted to the emergency department (ED). Methods This observational clinical study was conducted in the ED of the Ankara City Hospital during the period April 1–30, 2020. Patients who were admitted to the ED were triaged as COVID-19 infected and who agreed to undergo LUS/LCT (lung computed tomography) were included in the study. Results Included in the study were 40 patients who had been prediagnosed with COVID-19. Pneumonia was detected with LCT in 32 (80%) patients, while the LUS examination identified pneumonia in 23 patients. The most common finding in LCT was ground-glass opacity ( n = 29, 90.6%). Of the 23 patients with pneumonia findings in LUS, 15 (65.2%) had direct consolidation. Among the 32 patients who were found to have pneumonia as a result of LCT, 20 (62.5%) had signs of pneumonia on LUS examination, and 12 had no signs of pneumonia. In addition, 3 patients showed no signs of pneumonia with LCT, but they were misdiagnosed with pneumonia by LUS. The sensitivity of LUS in the diagnosis of pneumonia in the COVID-19 patients was 62.5%, while its specificity was 62.5%. In addition, its positive predictive value was 87.0%, and its negative predictive value was 29.4%. Conclusion LUS may also be used in the diagnosis of pneumonia in COVID-19 patients because it is a valuable and accessible bedside diagnostic tool. Electronic supplementary material The online version of this article (10.1007/s10049-020-00807-3) shows RT-PCR results of patients with a definitive diagnosis of COVID-19 by lung computed tomography and patients with pneumonia detected by lung ultrasonography. The article and additional material are available at www.springermedizin.de . Please enter the title of the article in the search field. You will find the additional material under “Ergänzende Inhalte” in the article.

Lung Ultrasound using a Handheld Device to Diagnose COVID-19 in the Emergency Department

“…Despite a larger average score in COVID-19, our data showed that the total LUSS score was not significantly different between COVID-19 patients and controls when using RT-PCR as the reference test. The modest diagnostic performance we observed corresponds with what Şan et al [21] had reported (62.5% sensitivity and specificity). Raiteri et al [22] used the relatively similar intensive care unit LUS scoring system and reported low sensitivity (66.7%) but slightly better specificity (85.6%).…”

“…The diagnostic performance discrepancy noticeable in the LUS in COVID-19 literature can be explained by the varying definitions of LUS outcome measure (i.e., how to interpret the images). Some studies have merely used any presence of B-lines or consolidations indicative of COVID-19 [21,25,27,32]. Others developed an arbitrary LUS scoring system based on a 5-point Likert scale [24] or a 6-point system [28].…”

A Comparison of Lung Ultrasound and Computed Tomography in the Diagnosis of Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Our study identified nine studies comparing LUS with CT for the diagnosis of interstitial pneumonia caused by COVID-19 [8][9][10][11][12][13][14][15][16]. In four out of five cases the diagnoses done by LUS and CT were in agreement.…”

“…A total of 1896 documents were retrieved. After reading the titles, abstracts, and full text of the documents, nine articles were included in the analysis [8][9][10][11][12][13][14][15][16] (Figure 1).…”

Early Lung Ultrasound Findings in Patients With COVID‐19 Pneumonia: A Retrospective Multicenter Study of 479 Patients

“… 2 Although most patients experience mild disease, 14% of patients have lung involvement. 3 , 4 As a result, lung imaging is pivotal in every recommendation for guiding the diagnosis and management of COVID‐19 patients. 1 , 5 …”