Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic has critically struck healthcare systems and burdened emergency services. To date, there is no accurate and rapid point-of-care diagnostic test. This study aimed to investigate Lung Ultrasound (LUS) against Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test in suspected COVID-19 patients presenting to the emergency department. In 20 eligible patients (mean age ± standard deviation, 49 ± 15 years), 12 had a positive RT-PCR test and undergone an LUS examination over 12 lung zones using a handheld ultrasound device. Each zone was semiquantitatively scored according to the Lung Ultrasound Scoring System (LUSS) from 0 to 3 based on the severity of findings (pleural line irregularity, B-lines, consolidations) and documented the presence of light beam artifacts. A second blinded reader scored the images to investigate interreader reproducibility. The LUSS score had a modest diagnostic performance at 66.6% [95% Confidence Interval (CI), 34.9–90.0%] sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. The light beam artifact was more prevalent and sensitive to COVID-19 patients with 81.8% (95% CI, 48.2–97.7%) sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. LUS had an almost perfect interreader reproducibility for LUSS (Kendall’s W = 0.961; 95% CI, 0.894–0.985) and light beam artifact (Cohen’s κ = 0.890; 95% CI, 0.683–1.00). Overall, LUS using handheld devices can offer a safe, reproducible, rapid, and feasible first-line tool for detecting COVID-19 patients in emergency departments. The light beam artifact was more sensitive and specific to COVID-19 patients and can be useful for effectively triaging suspected cases.
Highlights
Numerous healthcare systems are facing the daily challenges of managing the Coronavirus Disease 2019 (COVID-19) pandemic
This study aims to investigate the diagnostic performance of Lung Ultrasound (LUS) patterns in detecting COVID-19 using a handheld ultrasound device compared to Reverse Transcription-Polymerase Chain Reaction (RT-PCR) in symptomatic patients presenting to the emergency department
The complete patient characteristics including blood gas analysis results are included in Supplementary Table S1
Summary
Numerous healthcare systems are facing the daily challenges of managing the Coronavirus Disease 2019 (COVID-19) pandemic. The virus spread worldwide, and close to 2.5 million lives were lost as of early 2021. Recent reports suggest that the actual COVID-19 attributable mortality is reflected by more than 20.5 million years of life lost globally [1]. Despite the recent breakthroughs and distribution of vaccines, a recent survey showed that 89% of scientists believe the virus is “here to stay” for years because it has spread worldwide where global eradication is unlikely [3]. Emergency physicians are confronted with large cohorts of suspected cases amidst this pandemic. They are searching for feasible and accurate diagnostic instruments to identify suspected cases.
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