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Systematic review
Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: a systematic review and meta-analysis
  1. Ashley Matthies1,2,
  2. Michael Trauer2,3,
  3. Karl Chopra1,2,
  4. Robert David Jarman4
  1. 1 Emergency Department, Homerton University Hospital NHS Foundation Trust, London, UK
  2. 2 School of Health and Life Sciences, Teesside University, Middlesbrough, UK
  3. 3 Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  4. 4 Accident and Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  1. Correspondence to Dr Ashley Matthies, Emergency Department, Homerton University Hospital NHS Foundation Trust, London, London, UK; ashley.matthies{at}nhs.net

Abstract

Background Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. The necessity for rapid testing combined with the limitations of other diagnostic tests has led to the proposal of various potential roles for LUS during the COVID-19 pandemic. This systematic review and meta-analysis focused specifically on the diagnostic accuracy of LUS in adult patients presenting with suspected COVID-19 infection.

Methods Traditional and grey-literature searches were performed on 1 June 2021. Two authors independently carried out the searches, selected studies and completed the Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2). Meta-analysis was carried out using established open-source packages in R. We report overall sensitivity, specificity, positive and negative predictive values, and the hierarchical summary receiver operating characteristic curve for LUS. Heterogeneity was determined using the I2 statistic.

Results Twenty studies were included, published between October 2020 and April 2021, providing data from a total of 4314 patients. The prevalence and admission rates were generally high across all studies. Overall, LUS was found to be 87.2% sensitive (95% CI 83.6 to 90.2) and 69.5% specific (95% CI 62.2 to 72.5) and demonstrated overall positive and negative likelihood ratios of 3.0 (95% CI 2.3 to 4.1) and 0.16 (95% CI 0.12 to 0.22), respectively. Separate analyses for each reference standard revealed similar sensitivities and specificities for LUS. Heterogeneity was found to be high across the studies. Overall, the quality of studies was low with a high risk of selection bias due to convenience sampling. There were also applicability concerns because all studies were undertaken during a period of high prevalence.

Conclusion During a period of high prevalence, LUS had a sensitivity of 87% for the diagnosis of COVID-19 infection. However, more research is required to confirm these results in more generalisable populations, including those less likely to be admitted to hospital.

PROSPERO registration number CRD42021250464

  • COVID-19
  • ultrasonography
  • pneumonia

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/emermed-2021-212092

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • Handling editor Richard Body

    • Twitter @AshleyMatthies, @michael_trauer

    • Contributors All four authors contributed significantly to the design of the study and manuscript preparation. Three authors performed the literature searches, selected studies and extracted data (AM, MT, RDJ). Two authors completed the meta-analysis (AM, KC). AM is the guarantor of the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.