Article Text

Diagnostic accuracy of point-of-care lung ultrasound in COVID-19
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  1. Svenja L Haak1,
  2. Iris JE Renken1,
  3. L Cara Jager1,
  4. Heleen Lameijer2,
  5. Brigitta (Britt) YM van der Kolk1
  1. 1Emergency Department, Isala, Zwolle, the Netherlands
  2. 2Emergency Department, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
  1. Correspondence to Dr Brigitta (Britt) YM van der Kolk, Emergency Medicine, Isala, Zwolle, the Netherlands; b.y.m.van.der.kolk{at}isala.nl

Abstract

Background A promising modality for diagnosing pulmonary manifestations of COVID-19 in the emergency department (ED) is point-of-care ultrasound (POCUS) of the lungs. The currently used PCR as well as chest X-ray and CT scanning have important disadvantages. The aim of this study is to evaluate the diagnostic accuracy of POCUS in patients with suspected pulmonary manifestations of COVID-19 in the ED.

Methods This prospective diagnostic accuracy study was conducted at the ED of our non-academic level 1 trauma centre (Isala, Zwolle, the Netherlands). Patients were enrolled between 14 April and 22 April 2020. Patients (aged ≥16 years) with suspected COVID-19 presenting to the ED underwent POCUS. All patients received current standard of care, including PCR (naso-oropharyngeal swab). Outcome of POCUS was compared with PCR or CT scan outcome to determine diagnostic accuracy. Diagnostic accuracy measures were calculated using 2×2 contingency tables.

Results 100 patients were eligible to participate in this study, data of 93 patients were analysed. 27 (29%) patients were found positive for COVID-19 by PCR or CT. POCUS had a sensitivity of 89% (95% CI 70% to 97%), specificity of 59% (95% CI 46% to 71%), negative predictive value of 93% (95% CI 79% to 98%) and positive predictive value of 47% (95% CI 33% to 61%). In a subgroup of patients without previous cardiopulmonary disease (n=37), POCUS had a sensitivity of 100% (95% CI 70% to 100%), specificity of 76% (95% CI 54% to 90%), negative predictive value of 100% (95% CI 79% to 100%) and positive predictive value of 67% (95% CI 41% to 86%).

Conclusion POCUS of the lungs could serve as a valuable, radiation-free tool for excluding pulmonary manifestations of COVID-19 in patients in the ED at the point of assessment, especially in patients without previous cardiopulmonary disease.

Trial registration Dutch Trial Register, No: NTR8544.

  • ultrasound
  • infectious diseases
  • SARS
  • respiratory
  • pneumonia/infections

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Footnotes

  • Handling editor Katie Walker

  • Twitter @Britt_NL

  • Contributors SLH, BYMK and IJER contributed to the data collection. HL contributed to the data analysis. SLH, HL, LCJ and BYMK contributed to the development of the study design and interpretation of the data. LCJ, IJER and HL contributed to the literature search. All authors critically revised the manuscript. All authors contributed substantially to writing, editing, revising and finalising the manuscript before submission. All authors approved the final version of the manuscript.

  • 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 consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. The research protocol (written in Dutch) and database are available upon request. Requests can be sent to SL Haak (s.l.haak@isala.nl). Reuse is permitted after consultation.

  • 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.

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