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Lung Ultrasonography for Risk Stratification in Patients with Coronavirus Disease 2019 (COVID-19): A Prospective
Thomas Brahier1, Jean-Yves Meuwly2, Olivier Pantet3
1Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland.
Insights
Lung ultrasonography (LUS) effectively risk-stratifies coronavirus disease 2019 (COVID-19) patients in the emergency department. Abnormal LUS findings correlate with disease severity, aiding in early patient triage.
Area of Science:
- Medical Imaging
- Pulmonology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) presents a significant global health challenge.
- Early risk stratification is crucial for managing COVID-19 patients effectively.
- Lung ultrasonography (LUS) has emerged as a potential tool for assessing respiratory conditions.
Purpose of the Study:
- To describe and compare lung ultrasonography (LUS) characteristics in COVID-19 patients.
- To evaluate the utility of LUS for risk stratification based on clinical outcomes.
- To assess the potential of LUS as an early triage tool in the emergency department.
Main Methods:
- Prospective observational study of polymerase chain reaction-confirmed COVID-19 adult patients.
- Standardized LUS protocol used for image acquisition within 24 hours of presentation.
- LUS findings were analyzed and compared between outpatients, hospitalized, and intubated/deceased patient groups.
Main Results:
- 91% of COVID-19 patients exhibited abnormal LUS findings.
- The proportion of lung involvement and specific LUS patterns (pleural thickening, B-lines) correlated with clinical outcomes.
- Normalized LUS scores demonstrated good discrimination between different patient outcome groups (AUC = 0.80).
Conclusions:
- Lung ultrasonography (LUS) is a promising, accessible tool for early risk stratification of COVID-19 patients.
- LUS findings can differentiate between patients with varying disease severity.
- Systematic LUS can aid emergency departments in efficient patient triage during the COVID-19 pandemic.
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.
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