Introduction Coronavirus disease 2019 (COVID-19) can be a life-threatening lung disease or a trivial upper respiratory infection depending on whether the alveoli are involved. Emergency department (ED) evaluation of symptomatic patients with normal vital signs is frequently limited to chest auscultation and oro-nasopharyngeal swabs. We tested the null hypothesis that patients being screened for COVID-19 in the ED with normal vital signs and without hypoxia would have a point-of-care lung ultrasound (LUS) consistent with COVID-19 less than 2% of the time. Methods We performed a retrospective, structured, blinded ultrasound review and chart review in patients 14 years or older with symptoms prompting ED evaluation for COVID-19. We excluded those with known congestive heart failure or other chronic lung conditions likely to cause excessive B-lines on LUS. We used a two-sided exact hypothesis test for binomial random variables. We measured LUS diagnostic performance using computed tomography as the gold standard. Results We reviewed 77 charts; 49 met inclusion criteria. Vital signs were normal in 30/49 patients; 10 (33%) of these patients had LUS consistent with viral pneumonitis. We rejected the null hypothesis (p-value <0.001). The treating physicians’ interpretations of their own point-of-care LUS had a sensitivity of 100% (95% confidence interval (CI), 74%, 100%), specificity 88% (95% CI, 47%, 100%), likelihood ratio (LR) positive of 5.8 (95% CI, 1.3, 25), and LR negative of 0.05 (95% CI, 0.03, 0.71) when compared to CT findings. Conclusion LUS had a meaningful detection rate for pneumonitis in symptomatic ED patients with normal vital signs who were being evaluated for COVID-19. We recommend at least LUS be used in addition to polymerase chain reaction testing when evaluating symptomatic ED patients for COVID-19.
【초록키워드】 COVID-19, coronavirus disease, Coronavirus disease 2019, hypoxia, diagnostic, lung, Lung disease, Symptom, emergency department, Computed tomography, polymerase chain reaction, point-of-care, sensitivity, specificity, respiratory infection, Viral, Symptomatic patients, symptomatic, Chest, swabs, Patient, Interpretation, gold, vital signs, vital sign, congestive heart failure, Pneumonitis, respiratory, detection rate, retrospective, alveoli, Chain Reaction, random variables, Older, P-value, 95% CI, 95% confidence interval, null hypothesis, gold standard, upper respiratory infection, inclusion criteria, CT findings, Polymerase chain reaction testing, life-threatening, likelihood ratio, random, positive, polymerase, hypothesis test, polymerase chain, Result, tested, performed, blinded, involved, addition, evaluated, screened, condition, less, excluded, symptomatic patient, two-sided, variables, with COVID-19, 【제목키워드】 COVID-19, emergency department, Ultrasound, Emergency, Department,