TY - JOUR
T1 - Lung Ultrasound Findings Are Associated with Mortality and Need for Intensive Care Admission in COVID-19 Patients Evaluated in the Emergency Department
AU - Bonadia, Nicola
AU - Carnicelli, Annamaria
AU - Piano, Alfonso
AU - Buonsenso, Danilo
AU - Gilardi, Emanuele
AU - Kadhim, Cristina
AU - Torelli, Enrico
AU - Petrucci, Martina
AU - Di Maurizio, Luca
AU - Biasucci, Daniele Guerino
AU - Fuorlo, Mariella
AU - Forte, Evelina
AU - Zaccaria, Raffaella
AU - Franceschi, Francesco
N1 - Funding Information:
We express our gratitude to Riccardo Inchingolo and Andrea Smargiassi, who, as members of the Italian Academy of Thoracic Ultrasound (Accademia Italiana di Ecografia Toracica, ADET), have provided training on chest ultrasound findings in COVID-19 to all health care personnel of our hospital involved in the management of COVID-19 patients. We also thank all the health care personnel of our hospital, particularly those in the Emergency Department, for their invaluable support and for their bravery and commitment during the COVID-19 pandemic. This study would not have been possible without them. All the authors vouch that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Publisher Copyright:
© 2020 World Federation for Ultrasound in Medicine & Biology
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Lung ultrasound (LUS) has recently been advocated as an accurate tool to diagnose coronavirus disease 2019 (COVID-19) pneumonia. However, reports on its use are based mainly on hypothesis studies, case reports or small retrospective case series, while the prognostic role of LUS in COVID-19 patients has not yet been established. We conducted a prospective study aimed at assessing the ability of LUS to predict mortality and intensive care unit admission of COVID-19 patients evaluated in a tertiary level emergency department. Patients in our sample had a median of 6 lung areas with pathologic findings (inter-quartile range [IQR]: 6, range: 0–14), defined as a score different from 0. The median rate of lung areas involved was 71% (IQR: 64%, range: 0–100), while the median average score was 1.14 (IQR: 0.93, range: 0–3). A higher rate of pathologic lung areas and a higher average score were significantly associated with death, with an estimated difference of 40.5% (95% confidence interval [CI]: 4%–68%, p = 0.01) and of 0.47 (95% CI: 0.06–0.93, p = 0.02), respectively. Similarly, the same parameters were associated with a significantly higher risk of intensive care unit admission with estimated differences of 29% (95% CI: 8%–50%, p = 0.008) and 0.47 (95% CI: 0.05–0.93, p = 0.02), respectively. Our study indicates that LUS is able to detect COVID-19 pneumonia and to predict, during the first evaluation in the emergency department, patients at risk for intensive care unit admission and death.
AB - Lung ultrasound (LUS) has recently been advocated as an accurate tool to diagnose coronavirus disease 2019 (COVID-19) pneumonia. However, reports on its use are based mainly on hypothesis studies, case reports or small retrospective case series, while the prognostic role of LUS in COVID-19 patients has not yet been established. We conducted a prospective study aimed at assessing the ability of LUS to predict mortality and intensive care unit admission of COVID-19 patients evaluated in a tertiary level emergency department. Patients in our sample had a median of 6 lung areas with pathologic findings (inter-quartile range [IQR]: 6, range: 0–14), defined as a score different from 0. The median rate of lung areas involved was 71% (IQR: 64%, range: 0–100), while the median average score was 1.14 (IQR: 0.93, range: 0–3). A higher rate of pathologic lung areas and a higher average score were significantly associated with death, with an estimated difference of 40.5% (95% confidence interval [CI]: 4%–68%, p = 0.01) and of 0.47 (95% CI: 0.06–0.93, p = 0.02), respectively. Similarly, the same parameters were associated with a significantly higher risk of intensive care unit admission with estimated differences of 29% (95% CI: 8%–50%, p = 0.008) and 0.47 (95% CI: 0.05–0.93, p = 0.02), respectively. Our study indicates that LUS is able to detect COVID-19 pneumonia and to predict, during the first evaluation in the emergency department, patients at risk for intensive care unit admission and death.
KW - COVID-19
KW - Emergency medicine
KW - Lung ultrasound
KW - Pneumonia
KW - SARS-CoV-2
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U2 - 10.1016/j.ultrasmedbio.2020.07.005
DO - 10.1016/j.ultrasmedbio.2020.07.005
M3 - Article
C2 - 32798003
AN - SCOPUS:85089290188
VL - 46
SP - 2927
EP - 2937
JO - Ultrasound in Medicine and Biology
JF - Ultrasound in Medicine and Biology
SN - 0301-5629
IS - 11
ER -