The association of lung ultrasound images with COVID-19 infection in an emergency room cohort

S Bar, A Lecourtois, M Diouf, E Goldberg, C Bourbon, E Arnaud, L Domisse, H Dupont, P Gosset, S Bar, A Lecourtois, M Diouf, E Goldberg, C Bourbon, E Arnaud, L Domisse, H Dupont, P Gosset

Abstract

Lung ultrasound could facilitate the triage of patients with suspected COVID-19 infection admitted to the emergency room. We developed a predictive model for COVID-19 diagnosis based on lung ultrasound and clinical features. We used ultrasound to image the lung bilaterally at two anterior sites, one and two hands below each clavicle, and a posterolateral site that was the posterior transverse continuation from the lower anterior site. We studied 100 patients, 31 of whom had a COVID-19 positive reverse transcriptase polymerase chain reaction. A positive test was independently associated with: quick sequential organ failure assessment score ≥1; ≥3 B-lines at the upper site; consolidation and thickened pleura at the lower site; and thickened pleura line at the posterolateral site. The model discrimination was an area (95%CI) under the receiver operating characteristic curve of 0.82 (0.75-0.90). The characteristics (95%CI) of the model's diagnostic threshold, applied to the population from which it was derived, were: sensitivity, 97% (83-100%); specificity, 62% (50-74%); positive predictive value, 54% (41-98%); and negative predictive value, 98% (88-99%). This model may facilitate triage of patients with suspected COVID-19 infection admitted to the emergency room.

Trial registration: ClinicalTrials.gov NCT04368338.

Keywords: COVID-19; lung ultrasound; triage.

© 2020 Association of Anaesthetists.

Figures

Figure 1
Figure 1
(a) Lower anterior chest subpleural consolidation associated with thickened pleura. (b) The ‘bed‐side lung ultrasound in emergency’ (BLUE) protocol interrogates three points in each hemithorax. The two anterior sites are under one (upper) and two (lower) hands placed below each clavicle. The posterolateral site is the posterior transverse continuation from the lower anterior site, interrogated as posterior as possible in the supine patient
Figure 2
Figure 2
Study flow chart detailing complications in case of positive RT‐PCR and other aetiologies in case of negative RT‐PCR. ARDS, acute respiratory distress syndrome; ICU, intensive care unit; RT‐PCR, reverse transcription polymerase chain reaction

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Source: PubMed

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