Abstract
BackgroundDuring the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068).ResultsThe primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 ± 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 ± 6.7 vs. 21 ± 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001).ConclusionsIn COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.
Highlights
During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments
Patients with severe COVID-19 commonly meet the criteria for acute respiratory distress syndrome (ARDS), which is defined as the acute onset of bilateral infiltrates, severe hypoxemia, and lung edema that is not fully explained by cardiac failure or fluid overload [6]
Even though it can meet the ARDS Berlin definition, COVID-19 pneumonia is a specific disease with peculiar phenotypes, and some investigators propose the presence of two types of patients (“non-ARDS” or type 1, and ARDS or type 2) with different pathophysiologies, distinguishable by chest computed tomography (CT) [7]
Summary
During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Managing available resources may be the key point to overcoming the surge of patients and saving lives [3] In this context, tools to assess disease severity and de Alencar et al Ann. Intensive Care (2021) 11:6 prognosis in COVID-19 patients are one of the most important assets in reducing the burden on emergency departments. Patients with severe COVID-19 commonly meet the criteria for acute respiratory distress syndrome (ARDS), which is defined as the acute onset of bilateral infiltrates, severe hypoxemia, and lung edema that is not fully explained by cardiac failure or fluid overload [6]. Even though it can meet the ARDS Berlin definition, COVID-19 pneumonia is a specific disease with peculiar phenotypes, and some investigators propose the presence of two types of patients (“non-ARDS” or type 1, and ARDS or type 2) with different pathophysiologies, distinguishable by chest computed tomography (CT) [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
