Feasibility of using point-of-care lung ultrasound for early triage of COVID-19 patients in the emergency room
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ORIGINAL ARTICLE
Feasibility of using point-of-care lung ultrasound for early triage of COVID-19 patients in the emergency room Nick Narinx 1
&
Annick Smismans 2 & Rolf Symons 3 & Johan Frans 2 & Annick Demeyere 3 & Marc Gillis 4
Received: 14 June 2020 / Accepted: 31 August 2020 # American Society of Emergency Radiology 2020
Abstract Purpose Diagnostic value of point-of-care lung ultrasound (POCUS) in detection of coronavirus disease (COVID-19) in an emergency setting is currently unclear. In this study, we aimed to compare diagnostic performance, in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of POCUS lung, chest CT, and RT-PCR for clinically suspected COVID-19 infections in patients submitting to the emergency room (ER). Material and methods This retrospective study enrolled 93 patients with a suspected COVID-19 infection, admitted to the ER between March 28th and April 20th, 2020. Test subjects showed one or more symptoms of an acute respiratory infection, for which consequent COVID-19 testing was achieved using POCUS lung, chest CT, and RT-PCR. CT images were analyzed by 2 radiologists blinded to RT-PCR results. POCUS lung was performed by three emergency medical doctors, and reports were analyzed by the researcher, blinded to clinical information, US imaging, CT, and RT-PCR test results. Results Compared with RT-PCR, POCUS lung demonstrated outstanding sensitivity and NPV (93.3% and 94.1% respectively) while showing poor values for specificity, PPV, and accuracy (21.3%, 19.2%, and 33.3% respectively). In contrast, similar inquiries using chest CT as index test, excellent sensitivity, specificity, NPV, and accuracy (80.0%, 86.7%, 95.6%, and 85.6%, respectively) were reported, beside a moderate value for PPV (54.5%). Conclusion POCUS may provide early ER triage with a useful, rapid, low-threshold, and safe screening tool in evaluating possible COVID-19 infections. Due to limited specificity, suggestive POCUS lung findings should be confirmed with RTPCR or chest CT. Keywords POCUS lung . Emergency room . Sensitivity . Negative predictive value . COVID-19
Introduction In December 2019, multiple clusters of patients presenting with pneumonia of unknown cause were reported by Chinese healthcare facilities, which were later on revealed as infections due to a novel betacoronavirus. The identification of the genome of this virus, presently known as severe acute respiratory syndrome coronavirus 2 (SARS* Nick Narinx [email protected] 1
Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
2
Department of Microbiology, Imelda Hospital, Bonheiden, Belgium
3
Department of Radiology, Imelda Hospital, Bonheiden, Belgium
4
Department of Emergency Medicine, Imelda Hospital, Bonheiden, Belgium
CoV-2), connects it to RNA viruses that caused the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) [1]. Since its appearance on Chinese territory, the virus has spread to over 200 countries a
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