The role of lung ultrasound as a frontline diagnostic tool in the era of COVID-19 outbreak
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The role of lung ultrasound as a frontline diagnostic tool in the era of COVID‑19 outbreak Cristina Sorlini1 · Marco Femia2 · Giovanni Nattino3 · Pietro Bellone4 · Elisa Gesu4 · Paolo Francione6 · Michele Paternò5 · Pasquale Grillo5 · Aurora Ruffino5 · Guido Bertolini3 · Maurizio Cariati2 · Francesca Cortellaro1 · the Fenice Network (Italian Group for Clinical Research in Emergency Medicine) Received: 1 June 2020 / Accepted: 29 September 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract The diffusion of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) worldwide prompted the World Health Organization to declare the status of pandemic. The molecular diagnosis of SARS-CoV-2 infection is based on the detection of viral RNA on different biological specimens. Unfortunately, the test may require several hours to be performed. In the present study, we evaluated the diagnostic accuracy of lung point-of-care ultrasound (POCUS) for SARS-CoV-2 pneumonia in a cohort of symptomatic patients admitted to one emergency department (ED) in a high-prevalence setting. This retrospective study enrolled all patients who visited one ED with suspected respiratory infection in March 2020. All the patients were tested (usually twice if the first was negative) for SARS-CoV-2 on ED admission. The reference standard was considered positive if at least one specimen was positive. If all the specimens tested negative, the reference was considered negative. Diagnostic accuracy was evaluated using sensitivity, specificity, and positive and negative predictive value. Of the 444 symptomatic patients who were admitted to the ED in the study period, the result of the lung POCUS test was available for 384 (86.5%). The sensitivity of the test was 92.0% (95% CI 88.2–94.9%), and the specificity was 64.9% (95% CI 54.6–74.4%). We observed a prevalence of SARS-CoV-2 infection of 74.7%. In this setting, the positive and negative predicted values were 88.6% (95% CI 84.4–92.0) and 73.3% (95% CI 62.6–82.2%), respectively. Lung POCUS is a sensitive first-line screening tool for ED patients presenting with symptoms suggestive of SARS-CoV-2 infection. Keywords COVID-19 · SARS-CoV-2 · Point-of-care ultrasound · Diagnostic test · Sensitivity · Specificity
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-020-02524-8) contains supplementary material, which is available to authorized users. * Giovanni Nattino [email protected] 1
Accident and Emergency Services, ASST Santi Paolo e Carlo, Via Pio II 3, 20153 Milan, Italy
2
Department of Advanced Diagnostic‑Therapeutic Technologies, ASST Santi Paolo e Carlo, Via Pio II 3, 20153 Milan, Italy
3
Laboratory of Clinical Epidemiology, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via G.B. Camozzi 3, 24020 Ranica, BG, Italy
Coronavirus disease 19 (COVID-19) represents a new challenge among infectious diseases. It was first described in early
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