Abstract
IntroductionCurrent recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR.MethodsThis was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as part of their diagnostic evaluation. The primary objective was to estimate the test characteristics of both LUS B-lines and CXR for the associated diagnosis of COVID-19. Our secondary objective was to evaluate the proportion of patients with COVID-19 that have secondary LUS findings of pleural abnormalities and subpleural consolidations.ResultsWe identified 43 patients who underwent both LUS and CXR and were tested for COVID-19. Of these, 27/43 (63%) tested positive. LUS was more sensitive (88.9%, 95% confidence interval (CI), 71.1–97.0) for the associated diagnosis of COVID-19 than CXR (51.9%, 95% CI, 34.0–69.3; p = 0.013). LUS and CXR specificity were 56.3% (95% CI, 33.2–76.9) and 75.0% (95% CI, 50.0–90.3), respectively (p = 0.453). Secondary LUS findings of patients with COVID-19 demonstrated 21/27 (77.8%) had pleural abnormalities and 10/27 (37%) had subpleural consolidations.ConclusionAmong patients who underwent LUS and CXR, LUS was found to have a higher sensitivity than CXR for the evaluation of COVID-19. This data could have important implications as an aid in the diagnostic evaluation of COVID-19, particularly where viral testing is not available or restricted. If generalizable, future directions would include defining how to incorporate LUS into clinical management and its role in screening lower-risk populations.
Highlights
Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR)
lung ultrasound (LUS) was more sensitive (88.9%, 95% confidence interval (CI), 71.1-97.0) for the associated diagnosis of COVID-19 than CXR (51.9%, 95% confidence intervals (CI), 34.0-69.3; p = 0.013)
Ground-glass opacities can manifest as thinner B-lines
Summary
Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Is primarily due to lung injury resulting in acute respiratory distress syndrome (ARDS).[2] The definition of ARDS has changed over time; using the 2012 Berlin definition it would include acute bilateral lung injury in the absence of fluid overload, causing hypoxemia and respiratory failure.[3] Physicians evaluating patients may wish to order radiographic imaging to screen for findings of COVID-19, evaluate severity of pulmonary involvement, or assess for alternative etiologies of illness. The American College of Radiology (ACR) recommended the use of portable chest radiograph (CXR) when medically necessary for patients with suspected or known COVID-19, which does not include screening purposes.[4] it is estimated that portable CXR is only 69% sensitive for findings of COVID-19.5
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