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{ "pk": 13778, "title": "Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19", "subtitle": null, "abstract": "Introduction:\n Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR.\nMethods: \nThis was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as part of their diagnostic evaluation. The primary objective was to estimate the test characteristics of both LUS B-lines and CXR for the associated diagnosis of COVID-19. Our secondary objective was to evaluate the proportion of patients with COVID-19 that have secondary LUS findings of pleural abnormalities and subpleural consolidations.\nResults:\n We identified 43 patients who underwent both LUS and CXR and were tested for COVID-19. Of these, 27/43 (63%) tested positive. LUS was more sensitive (88.9%, 95% confidence interval (CI), 71.1-97.0) for the associated diagnosis of COVID-19 than CXR (51.9%, 95% CI, 34.0-69.3; p = 0.013). LUS and CXR specificity were 56.3% (95% CI, 33.2-76.9) and 75.0% (95% CI, 50.0-90.3), respectively (p = 0.453). Secondary LUS findings of patients with COVID-19 demonstrated 21/27 (77.8%) had pleural abnormalities and 10/27 (37%) had subpleural consolidations.\nConclusion: \nAmong patients who underwent LUS and CXR, LUS was found to have a higher sensitivity than CXR for the evaluation of COVID-19. This data could have important implications as an aid in the diagnostic evaluation of COVID-19, particularly where viral testing is not available or restricted. If generalizable, future directions would include defining how to incorporate LUS into clinical management and its role in screening lower-risk populations.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "COVID-19, Coronavirus, Ultrasound, B-lines, Chest Radiograph" } ], "section": "Endemic Infections", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/1x83j2gv", "frozenauthors": [ { "first_name": "Joseph", "middle_name": "R.", "last_name": "Pare", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" }, { "first_name": "Ingrid", "middle_name": "", "last_name": "Camelo", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Pediatric Infectious Diseases, Boston, Massachusetts", "department": "None" }, { "first_name": "Kelly", "middle_name": "C.", "last_name": "Mayo", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" }, { "first_name": "Megan", "middle_name": "M.", "last_name": "Leo", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" }, { "first_name": "Julianne", "middle_name": "N.", "last_name": "Dugas", "name_suffix": "", "institution": "Boston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" }, { "first_name": "Kerrie", "middle_name": "P.", "last_name": "Nelson", "name_suffix": "", "institution": "Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts", "department": "None" }, { "first_name": "William", "middle_name": "E.", "last_name": "Baker", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" }, { "first_name": "Faizah", "middle_name": "", "last_name": "Shareef", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts", "department": "None" }, { "first_name": "Patrica", "middle_name": "M.", "last_name": "Mitchell R.N.", "name_suffix": "", "institution": "Boston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" }, { "first_name": "Elissa", "middle_name": "M.", "last_name": "Schechter-Perkins", "name_suffix": "", "institution": "Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts\nBoston Medical Center, Department of Emergency Medicine, \nBoston, Massachusetts", "department": "None" } ], "date_submitted": "2020-04-16T23:46:09+02:00", "date_accepted": "2020-04-16T23:46:09+02:00", "date_published": "2020-06-20T02:03:01+02:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/13778/galley/7177/download/" } ] }