Abstract
Background: Lung ultrasonography (LUS) is a promising pragmatic risk-stratification tool in coronavirus disease 2019 (COVID-19). This study describes and compares LUS characteristics between patients with different clinical outcomes.
Methods: Prospective observational study of polymerase chain reaction-confirmed adults with COVID-19 with symptoms of lower respiratory tract infection in the emergency department (ED) of Lausanne University Hospital. A trained physician recorded LUS images using a standardized protocol. Two experts reviewed images blinded to patient outcome. We describe and compare early LUS findings (≤24 hours of ED presentation) between patient groups based on their 7-day outcome (1) outpatients, (2) hospitalized, and (3) intubated/dead. Normalized LUS score was used to discriminate between groups.
Results: Between 6 March and 3 April 2020, we included 80 patients (17 outpatients, 42 hospitalized, and 21 intubated/dead). Seventy-three patients (91%) had abnormal LUS (70% outpatients, 95% hospitalized, and 100% intubated/dead; P = .003). The proportion of involved zones was lower in outpatients compared with other groups (median [IQR], 30% [0-40%], 44% [31-70%], 70% [50-88%]; P < .001). Predominant abnormal patterns were bilateral and there was multifocal spread thickening of the pleura with pleural line irregularities (70%), confluent B lines (60%), and pathologic B lines (50%). Posterior inferior zones were more often affected. Median normalized LUS score had a good level of discrimination between outpatients and others with area under the ROC of .80 (95% CI, .68-.92).
Conclusions: Systematic LUS has potential as a reliable, cheap, and easy-to-use triage tool for the early risk stratification in patients with COVID-19 presenting to EDs.
Keywords: COVID-19; LUS score; lung ultrasound; triage tool.
【저자키워드】 COVID-19, Lung ultrasound, LUS score, triage tool., 【초록키워드】 coronavirus disease, Hospitalized, Infection, lung, Symptom, outcome, clinical outcomes, Spread, risk stratification, Characteristics, ROC, Prospective, Patient, outpatients, group, university, Outpatient, Pragmatic, Lower respiratory tract, Lung Ultrasonography, 95% CI, zone, pleura, standardized protocol, polymerase chain, affected, was used, blinded, involved, proportion, pathologic, patient group, median, groups, presenting, recorded, normalized, patients with COVID-19, Posterior, with COVID-19, 【제목키워드】 Prospective, Ultrasonography,