Abstract
Background and objectivesPatients infected with influenza and COVID-19 exhibit similar clinical presentations; thus, a point-of-care test to differentiate between the diseases is needed. Here, we sought to identify features of point-of-care lung ultrasound (LUS) that can discriminate between influenza and COVID-19.MethodsIn this prospective, cross-sectional study, LUS clips of patients presenting to the emergency department (ED) with viral-like symptoms were collected via a 10-zone scanning protocol. Deidentified clips were interpreted by emergency ultrasound fellows blinded to patients’ clinical context and influenza or COVID-19 diagnosis. Modified Soldati scores were calculated for each lung zone. Logistic regression identified the association of pulmonary pathologies with each disease.ResultsUltrasound fellows reviewed LUS clips from 165 patients, of which 30.9% (51/165) had confirmed influenza, 33.9% (56/165) had confirmed COVID-19, and 35.1% (58/165) had neither disease. Patients with COVID-19 were more likely to have irregular pleura and B-lines in all lung zones (p<0.01). The median-modified Soldati score for influenza patients was 0/20 (IQR 0-2), 9/20 (IQR 2.5-15.5) for COVID-19 patients, and 2/20 (IQR 0-8) for patients with neither disease (p<0.0001). In multivariate regression analysis adjusted for age, sex, and congestive heart failure (CHF), the presence of B-lines (OR = 1.29, 95% CI 1.09-1.53) was independently associated with COVID-19 diagnosis. The presence of pleural effusion was inversely associated with COVID-19 (OR = 0.09, 95% CI 0.01-0.65).ConclusionsLUS may help providers preferentially identify the presence of influenza versus COVID-19 infection both visually and by calculating a modified Soldati score. Further studies assessing the utility of LUS in differentiating viral illnesses in patients with variable illness patterns and those with variable illness severity are warranted.
Highlights
Each year, respiratory viruses, including influenza, run rampant throughout the global community
In multivariate regression analysis adjusted for age, sex, and congestive heart failure (CHF), the presence of B-lines (OR = 1.29, 95% CI 1.09-1.53) was independently associated with COVID-19 diagnosis
lung ultrasound (LUS) may help providers preferentially identify the presence of influenza versus COVID-19 infection both visually and by calculating a modified Soldati score
Summary
Respiratory viruses, including influenza, run rampant throughout the global community. Patients with influenza and COVID-19 often present with similar symptoms, including cough, sore throat, myalgias, fatigue, fever, and shortness of breath [3]. Differentiating these diseases based on clinical context alone can be challenging. Computed tomography (CT) imaging can accurately detect pulmonary disease, its role in the pandemic has been inconsistent due to challenges associated with scanner availability, unnecessary radiation exposure, How to cite this article Goldsmith A J, Al Saud A, Duggan N M, et al (January 11, 2022) Point-of-Care Lung Ultrasound for Differentiating COVID-19 From Influenza. Patients infected with influenza and COVID-19 exhibit similar clinical presentations; a point-of-care test to differentiate between the diseases is needed. We sought to identify features of point-of-care lung ultrasound (LUS) that can discriminate between influenza and COVID-19
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