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Combatting COVID-19: is ultrasound an important piece in the diagnostic puzzle?
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  1. Cian McDermott1,2,
  2. Joseph Daly1,2,
  3. Simon Carley3,4
  1. 1Department of Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2The Pillar Centre for Transformative Healthcare, Mater Misericordiae University Hospital, Dublin, Ireland
  3. 3Department of Emergency Medicine, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, Greater Manchester, UK
  4. 4Department of Emergency Medicine, Manchester Metropolitan University - All Saints Campus, Manchester, Greater Manchester, UK
  1. Correspondence to Dr Cian McDermott, Emergency Medicine, Mater Misericordiae University Hospital, Dublin D07 R2WY, Ireland; cianmcdermott{at}gmail.com

Abstract

The current COVID-19 pandemic is causing diagnostic and risk stratification difficulties in Emergency Departments (ED) worldwide. Molecular tests are not sufficiently sensitive, and results are usually not available in time for decision making in the ED. Chest x-ray (CXR) is a poor diagnostic test for COVID-19, and computed tomography (CT), while sensitive, is impractical as a diagnostic test for all patients. Lung ultrasound (LUS) has an established role in the evaluation of acute respiratory failure and has been used during the COVID-19 outbreak as a decision support tool. LUS shows characteristic changes in viral pneumonitis, and while these changes are not specific for COVID-19, it may be a useful adjunct during the diagnostic process. It is quick to perform and repeat and may be done at the bedside. The authors believe that LUS can help to mitigate uncertainty in undifferentiated patients with respiratory symptoms. This review aims to provide guidance regarding indications for LUS, describe the typical sonographic abnormalities seen in patients with COVID-19 and provide recommendations around the logistics of performing LUS on patients with COVID-19 and managing the infection control risk of the procedure. The risk of anchoring bias during a pandemic and the need to consider alternative pathologies are emphasised throughout this review. LUS may be a useful point-of-care test for emergency care providers during the current COVID-19 pandemic if used within a strict framework that governs education, quality assurance and proctored scanning protocols.

  • ultrasound
  • emergency department
  • imaging
  • ultrasound
  • infectious diseases
  • viral

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https://bmj.com/coronavirus/usage
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Footnotes

  • Handling editor Ed Benjamin Graham Barnard

  • Twitter @cianmcdermott, @josephdaly111, @EMManchester

  • Contributors All authors have contributed to the design of the paper, the writing of the manuscript and have seen and approved the final manuscript; they all meet the definition of an author as stated by the International Committee of Medical Journal Editors.

  • 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.

  • Patient consent for publication Not required.

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

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