Utility of lung ultrasound score for severity categorization and CLUE protocol for disposition of COVID-19 patients presenting to emergency department

Abstract

Objective: Lung ultrasound is a point-of-care diagnostic work-up tool used extensively in emergency departments. The COVID-19 Lung Ultrasound in Emergency Department (CLUE) protocol has shown initial promise in aiding emergency clinicians to make rapid and appropriate bedside clinical decisions. Its primary objective is to assess the performance of the lung ultrasound scoring system (LUSS) in determining SARS-CoV-2 pneumonia severity so that the patients can be moved to their designated ICUs, wards, or facility quarantine center from the emergency department. Methods: A cross-sectional study was undertaken among adult patients with a confirmed diagnosis of SARS-CoV-2 infection who were admitted/referred to the All India Institute of Medical Sciences, Rishikesh, Uttarakhand. The data were descriptively analyzed using Graphpad Prism (vs. 9.2.0). Results: Out of 197 patients included in this study, 74.6% were men with a mean age of 45.3 ± 15.5 years. The men to women ratio was 2.9:1. The most frequent symptoms on presentation were fever (59.9% of cases), cough (54.3%), dyspnea (36%), and 16.2% of the patients were asymptomatic. The mean LUSS score of the patients with invasive support was 24.3 ± 4.5, as compared to 15.7 ± 5.9 in the non-invasive group. Overall, 64.4% patients did not require any respiratory support with a mean LUSS score of 2.3 ± 3.5. Out of 197 patients, 5 (2.5%) died during hospital stay. The mean LUSS score of survivors was 7.1 ± 8.2, as compared to 22.2 ± 4.3 of the deceased. Conclusion: The CLUE protocol can help in triaging the patients in the mild and moderate severity group and discharging them directly from the emergency department itself to either a facility quarantine center or to home isolation. It ultimately helps in avoiding unnecessary referrals, eliminating contamination, and optimum utilization of health resources.