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{
    "pk": 14376,
    "title": "Point-of-care Lung Ultrasound Is Useful to Evaluate Emergency Department Patients for COVID-19",
    "subtitle": null,
    "abstract": "Introduction: \nCoronavirus 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.\nMethods:\n 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.\nResults:\n 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.\nConclusion:\n 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.",
    "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"
        },
        {
            "word": "SARS-CoV-2"
        },
        {
            "word": "ultrasound"
        },
        {
            "word": "emergency department"
        }
    ],
    "section": "Endemic Infections",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/41q6k43n",
    "frozenauthors": [
        {
            "first_name": "Paul",
            "middle_name": "",
            "last_name": "Walsh",
            "name_suffix": "",
            "institution": "Sutter Medical Center Sacramento, Department of Emergency Medicine, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Andrea",
            "middle_name": "",
            "last_name": "Hankins",
            "name_suffix": "",
            "institution": "Sutter Institute for Medical Research, Sacramento, California",
            "department": "None"
        },
        {
            "first_name": "Heejung",
            "middle_name": "",
            "last_name": "Bang",
            "name_suffix": "",
            "institution": "University of California Davis, Department of Public Health Sciences, Davis, California",
            "department": "None"
        }
    ],
    "date_submitted": "2020-07-22T16:28:55Z",
    "date_accepted": "2020-07-22T16:28:55Z",
    "date_published": "2020-11-04T08:00:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/14376/galley/7380/download/"
        }
    ]
}