Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

Kosuke Yasukawa; Taro Minami; David R. Boulware; Ayako Shimada; Ernest A. Fischer

doi:10.1177/0885066620988831

Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

Kosuke Yasukawa, Taro Minami, David R. Boulware, Ayako Shimada, Ernest A. Fischer

Medicine - Infectious Disease and International Medicine

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

Abstract

BACKGROUND: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.

METHOD: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death.

RESULTS: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001).

CONCLUSIONS: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

Original language	English (US)
Pages (from-to)	334-342
Number of pages	9
Journal	Journal of Intensive Care Medicine
Volume	36
Issue number	3
DOIs	https://doi.org/10.1177/0885066620988831
State	Published - Mar 2021

Bibliographical note

Publisher Copyright:
© The Author(s) 2020.

Keywords

COVID-19
coronavirus
lung ultrasound
point-of-care ultrasound
viral pneumonia
Prognosis
Prospective Studies
Hospital Mortality
Lung/diagnostic imaging
Humans
Middle Aged
Length of Stay/statistics & numerical data
Male
Noninvasive Ventilation/statistics & numerical data
Respiration, Artificial/statistics & numerical data
Hospitalization
Intensive Care Units/statistics & numerical data
SARS-CoV-2
Point-of-Care Systems
COVID-19/diagnostic imaging
Ultrasonography
Female
Aged

PubMed: MeSH publication types

Observational Study
Journal Article

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10.1177/0885066620988831

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title = "Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients",

abstract = "BACKGROUND: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.METHOD: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death.RESULTS: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001).CONCLUSIONS: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.",

keywords = "COVID-19, coronavirus, lung ultrasound, point-of-care ultrasound, viral pneumonia, Prognosis, Prospective Studies, Hospital Mortality, Lung/diagnostic imaging, Humans, Middle Aged, Length of Stay/statistics & numerical data, Male, Noninvasive Ventilation/statistics & numerical data, Respiration, Artificial/statistics & numerical data, Hospitalization, Intensive Care Units/statistics & numerical data, SARS-CoV-2, Point-of-Care Systems, COVID-19/diagnostic imaging, Ultrasonography, Female, Aged",

author = "Kosuke Yasukawa and Taro Minami and Boulware, {David R.} and Ayako Shimada and Fischer, {Ernest A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2021",

month = mar,

doi = "10.1177/0885066620988831",

language = "English (US)",

volume = "36",

pages = "334--342",

journal = "Journal of Intensive Care Medicine",

issn = "0885-0666",

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number = "3",

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TY - JOUR

T1 - Point-of-Care Lung Ultrasound for COVID-19

T2 - Findings and Prognostic Implications From 105 Consecutive Patients

AU - Yasukawa, Kosuke

AU - Minami, Taro

AU - Boulware, David R.

AU - Shimada, Ayako

AU - Fischer, Ernest A.

N1 - Publisher Copyright: © The Author(s) 2020.

PY - 2021/3

Y1 - 2021/3

N2 - BACKGROUND: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.METHOD: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death.RESULTS: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001).CONCLUSIONS: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

AB - BACKGROUND: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward.METHOD: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death.RESULTS: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001).CONCLUSIONS: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

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KW - coronavirus

KW - lung ultrasound

KW - point-of-care ultrasound

KW - viral pneumonia

KW - Prognosis

KW - Prospective Studies

KW - Hospital Mortality

KW - Lung/diagnostic imaging

KW - Humans

KW - Middle Aged

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Noninvasive Ventilation/statistics & numerical data

KW - Respiration, Artificial/statistics & numerical data

KW - Hospitalization

KW - Intensive Care Units/statistics & numerical data

KW - SARS-CoV-2

KW - Point-of-Care Systems

KW - COVID-19/diagnostic imaging

KW - Ultrasonography

KW - Female

KW - Aged

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U2 - 10.1177/0885066620988831

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M3 - Article

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AN - SCOPUS:85100553337

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ER -

Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

Abstract

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Keywords

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