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October 13, 2021

Written by Christopher Thom – Academy of Emergency Ultrasound

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Point of care lung ultrasound findings are associated with poor outcomes and need for hospitalization in patients with COVID-19 pneumonia.

Why does this matter?
Increased pulmonary involvement is linked with disease severity and worse outcomes in patients with COVID-19 pneumonia. Identifying those patients with significant pulmonary involvement can assist the emergency physician in determining the likelihood of deterioration. Ultrasound is a readily available and easily employed diagnostic tool that may provide valuable information regarding the degree of pulmonary involvement in patients with COVID-19 pneumonia.  

Visualize the fluid in the lungs the easy way
This was a multicenter prospective, observational study of ED patents with COVID-19. Patients were included in the study over a two month period in 2020 if they had confirmed COVID-19 and had both a CT chest and lung ultrasound (LUS) performed. The authors sought to evaluate how well LUS predicted poor outcome (defined as 30-day mortality or ICU admission) and compared this to the predictive value of CT chest via the CT severity score (CTSS). They also assessed whether more severe disease on LUS was associated with hospital admission versus ED discharge. The authors used a previously described LUS score that assigns 12 lung zones a severity score of 0 to 3 (total score possible of 0 to 36).

114 patients met inclusion criteria. 24 patients were discharged home from the ED, 79 admitted to the general ward, and 12 required ICU admission. The mean LUS score for each of these groups was 6.3 (SD, 4.4), 13.1 (SD, 6.4), and 18.0 (SD, 5.0), respectively. This was statistically significant with an assigned p-value of <0.001. A LUS score of >12 was shown to have a hazard ratio of 5.49 (95% CI 1.24-24.34) for predicting mortality or ICU admission. LUS correlated well with the CTSS, k=0.60 (95% CI 0.48-0.71). Bottom line: More significant lung ultrasound findings in COVID-19 are associated with poor outcomes and hospital admission. The degree of additive predictive value this adds to widely used clinical data, such as oxygen saturation and respiratory rate, needs further study.

Assessing COVID-19 pneumonia-Clinical extension and risk with point-of-care ultrasound: A multicenter, prospective, observational study. J Am Coll Emerg Physicians Open. 2021 May 1;2(3):e12429. doi: 10.1002/emp2.12429.

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