Outcomes of Simplified Lung Ultrasound Exam in COVID-19: Implications for Self-Imaging.

Abstract

ObjectivesLung ultrasound B‐lines represent interstitial thickening or edema and relate to mortality in COVID‐19. As B‐lines can be detected with minimal training using point‐of‐care ultrasound (POCUS), we examined the frequency, clinical associations, and outcomes of B‐lines when found using a simplified POCUS method in acutely ill patients with COVID‐19.MethodsIn this retrospective cohort study, hospital data from COVID‐19 patients who had undergone lung imaging during standard echocardiography or POCUS were reviewed for an ultrasound lung comet (ULC) sign, defined as the presence of ≥3 B‐lines from images of only the antero‐apex of either lung (ULC+). Clinical risk factors, oximetry and radiographic results, and disease severity were analyzed for associations with ULC+. Clinical risk factors and ULC+ were analyzed for associations with hospital mortality or the need for intensive care in multivariable models.ResultsOf N = 160 patients, age (mean ± standard deviation) was 64.8 ± 15.5 years, and 46 (29%) died. ULC+ was present in 100/160 (62%) of patients overall, in 81/103 (79%) of severe‐or‐greater disease versus 19/57 (33%) of moderate‐or‐less disease (P < .0001) and was associated with mortality (odds ratio [OR] = 2.4 [95% confidence interval [CI]: 1.1–5.4], P = .02) and the need for intensive care (OR = 5.23 [95% CI: 2.42–12.40], P < .0001). In the multivariable models, symptom duration and severe‐or‐greater disease were associated with ULC+, and ULC+, diabetes, and symptom duration were associated with the need for intensive care.ConclusionsB‐lines in the upper chest were common and related to disease severity, intensive care, and hospital mortality in COVID‐19. Validation of a simplified lung POCUS exam could provide the evidence basis for a self‐imaging application during the pandemic.