Combining lung ultrasound and Wells score for diagnosing pulmonary embolism in critically ill COVID-19 patients
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Combining lung ultrasound and Wells score for diagnosing pulmonary embolism in critically ill COVID‑19 patients Viviane Zotzmann1,2 · Corinna N. Lang1,2 · Tobias Wengenmayer1,2 · Xavier Bemtgen1,2 · Bonaventura Schmid4 · Katharina Mueller‑Peltzer3 · Alexander Supady1,2,5 · Christoph Bode1,2 · Daniel Duerschmied1,2 · Dawid L. Staudacher1,2 Accepted: 24 October 2020 © The Author(s) 2020
Abstract Subpleural consolidations have been found in lung ultrasound in patients with COVID-19, possibly deriving from pulmonary embolism (PE). The diagnostic utility of impact of lung ultrasound in critical-ill patients with COVID-19 for PE diagnostics however is unclear. We retrospectively evaluated all SARS-CoV2-associated ARDS patients admitted to our ICU between March 8th and May 31th 2020. They were enrolled in this study, when a lung ultrasound and a computed tomography pulmonary angiography (CTPA) were documented. In addition, wells score was calculated to estimate the probability of PE. The CTPA was used as the gold standard for the detection of PE. Twenty out of 25 patients met the inclusion criteria. In 12/20 patients (60%) (sub-) segmental PE were detected by CT-angiography. Lung ultrasound found subpleural consolidations in 90% of patients. PE-typical large supleural consolidations with a size ≥ 1 cm were detectable in 65% of patients and were significant more frequent in patients with PE compared to those without (p = 0.035). Large consolidations predicted PE with a sensitivity of 77% and a specificity of 71%. The Wells score was significantly higher in patients with PE compared to those without (2.7 ± 0.8 and 1.7 ± 0.5, respectively, p = 0.042) and predicted PE with an AUC of 0.81. When combining the two modalities, comparing patients with considered/probable PE using LUS plus a Wells score ≥ 2 to patients with possible/ unlikely PE in LUS plus a Wells score 2, this might indicate a high-risk for PE in COVID-19. Keywords COVID-19 · Lung ultrasound · CTPA · Pulmonary embolism · SARS-CoV2 · Wells score Abbreviations PE Pulmonary embolism ARDS Acute respiratory distress syndrom Viviane Zotzmann and Corinna N. Lang have contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02323-0) contains supplementary material, which is available to authorized users. * Viviane Zotzmann viviane.zotzmann@universitaets‑herzzentrum.de 1
Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
2
LUS Lung ultrasound CTPA Computed tomography pulmonary angiography ECMO Veno-venous extracorporeal membrane oxygenation COVID-19 Corona-Virus Disease 2019 SD Standard deviation BMI Body mass index PAP sys Systolic pulmonary arterial pressure 3
Department of Diagnostic and Interventi
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