The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak

Sorlini, Cristina; Femia, Marco; Nattino, Giovanni; Bellone, Pietro; Gesu, Elisa; Francione, Paolo; Paternò, Michele; Grillo, Pasquale; Ruffino, Aurora; Bertolini, Guido; Cariati, Maurizio; Cortellaro, Francesca

doi:10.1007/s11739-020-02524-8

Cited by 38 publications

(52 citation statements)

References 35 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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“…Multiple studies are advocating radiologic imaging such as chest radiograph (CXR), chest ultrasound (US), lung ultrasound (LUS), and particularly chest computed tomography (chest CT) as complementary and, in some cases, as standard diagnosis method of COVID-19. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Patients who developed COVID-19 pneumonia shared similar lung abnormalities. 48 Peripheral ground-glass opacities, multiple bilateral consolidation, crazy paving patterns, and reticular pattern are standard features found in chest CT of pneumonia patients.…”

Section: Radiology-based Detectionmentioning

confidence: 99%

COVID-19 Pandemic: Review of Contemporary and Forthcoming Detection Tools

Oishee¹,

Ali²,

Jahan³

et al. 2021

IDR

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Recent severe acute respiratory syndrome 2 (SARS-CoV-2) known as COVID-19, presents a deadly challenge to the global healthcare system of developing and developed countries, exposing the limitations of health facilities preparedness for emerging infectious disease pandemic. Opportune detection, confinement, and early treatment of infected cases present the first step in combating COVID-19. In this review, we elaborate on various COVID-19 diagnostic tools that are available or under investigation. Consequently, cell culture, followed by an indirect fluorescent antibody, is one of the most accurate methods for detecting SARS-CoV-2 infection. However, restrictions imposed by the regulatory authorities prevented its general use and implementation. Diagnosis via radiologic imaging and reverse transcriptase PCR assay is frequently employed, considered as standard procedures, whereas isothermal amplification methods are currently on the verge of clinical introduction. Notably, techniques such as CRISPR-Cas and microfluidics have added new dimensions to the SARS-CoV-2 diagnosis. Furthermore, commonly used immunoassays such as enzyme-linked immunosorbent assay (ELISA), lateral flow immunoassay (LFIA), neutralization assay, and the chemiluminescent assay can also be used for early detection and surveillance of SARS-CoV-2 infection. Finally, advancement in the next generation sequencing (NGS) and metagenomic analysis are smoothing the viral detection further in this global challenge.

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“…Two previous study showed that thickened pleural lines on LUS were significantly associated with COVID-19 [17,18]. However, in a third report, LUS findings were similar in both COVID-19 and non-COVID-19 patients [19].…”

Section: Discussionmentioning

confidence: 88%

“…The limited sensitivity of LUS in our population is discordant with previous studies, which showed a good sensitivity (89-97%) to identify Rt-PCR-confirmed COVID-19. These retrospective studies were conducted in emergency departments and included patients with severe and critical COVID-19 infection[17–19]. Other studies using chest CT also showed an excellent sensitivity (97-98%) to diagnose COVID-19 [2,20,21].…”

Section: Discussionmentioning

confidence: 99%

Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center

Schaad

Brahier

Hartley

et al. 2021

Preprint

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Background Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening. Methods This prospective observational cohort included adults presenting with cough and/or dyspnea at a SARS-CoV-2 screening center of Lausanne University Hospital between March 31st and May 8th, 2020. Investigators recorded standardized LUS images and videos in 10 lung zones per subject. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to pre-specified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVIDpos vs COVIDneg). We finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score. Results Of 134 included patients, 23% (n=30/134) were COVIDpos and 77% (n=103/134) were COVIDneg; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2 to 5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVIDpos compared to COVIDneg (45% versus 26%, p=0.045) and mostly consisted of focal pathologic B-lines. Combining LUS findings in a multivariate logistic regression score had an area under the receiver-operating curve of 63.9% to detect COVID-19, but improved to 84.5% with the addition of clinical features. Conclusions COVIDpos patients are significantly more likely to have lung pathology by LUS. Our findings have potential diagnostic value for COVID-19 at the point of care. Combination of clinical and LUS features showed promising results, which need confirmation in a larger study population.

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The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak

Cited by 38 publications

References 35 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

COVID-19 Pandemic: Review of Contemporary and Forthcoming Detection Tools

Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center

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