Lung Ultrasound Integration in Assessment of Patients with Noncritical COVID-19

Performing lung ultrasound during the clinical assessment of patients with suspicion of noncritical COVID-19 may increase the diagnostic rate of pulmonary involvement over other diagnostic techniques used in routine clinical practice. This study aims to compare complications (readmissions, emergency department [ED] visits, and length of outpatient follow-up) in the first 30 days after ED discharge in patients with confirmed COVID-19 who were managed with versus without lung ultrasound.

Prospective, observational, analytical study in noncritical patients with confirmed respiratory disease due to SARS-CoV-2, assessed in the ED of a tertiary Spanish hospital in March and April 2020. We compared 2 cohorts, differentiated by the use of lung ultrasound as a diagnostic tool. Complications were assessed (hospital admissions, ED revisits and days of outpatient follow-up) at 30 days postdischarge.

Of the 88 included patients, 31% (n = 27) underwent an initial lung ultrasound, while 61 (68%) did not. In 82.5% of the patients evaluated with ultrasound, the most predominant areas affected were the posterobasal regions, in the form of focalized and confluent B-lines; 70.4% showed pleural irregularity in these same areas. Use of the lung ultrasound was associated with a greater probability of hospital admission (odds ratio 5.63, 95% confidence interval 3.31 to 9.57; p < 0.001). However, it was not significantly associated with mortality or short-term complications.

Lung ultrasound could identify noncritical patients with lung impairment due to SARS-CoV-2, in whom other tests used routinely show no abnormalities. However, it has not shown a prognostic value in these patients and could generate a higher percentage of hospital admissions. More studies are still needed to demonstrate the clear benefit of this use.