Diagnostic accuracy of point-of-care lung ultrasound in COVID-19.

Autor:	Haak SL; Emergency Department, Isala, Zwolle, the Netherlands., Renken IJ; Emergency Department, Isala, Zwolle, the Netherlands., Jager LC; Emergency Department, Isala, Zwolle, the Netherlands., Lameijer H; Emergency Department, Medical Centre Leeuwarden, Leeuwarden, the Netherlands., van der Kolk BBY; Emergency Department, Isala, Zwolle, the Netherlands b.y.m.van.der.kolk@isala.nl.
Jazyk:	angličtina
Zdroj:	Emergency medicine journal : EMJ [Emerg Med J] 2021 Feb; Vol. 38 (2), pp. 94-99. Date of Electronic Publication: 2020 Nov 18.
DOI:	10.1136/emermed-2020-210125
Abstrakt:	Background: A promising modality for diagnosing pulmonary manifestations of COVID-19 in the emergency department (ED) is point-of-care ultrasound (POCUS) of the lungs. The currently used PCR as well as chest X-ray and CT scanning have important disadvantages. The aim of this study is to evaluate the diagnostic accuracy of POCUS in patients with suspected pulmonary manifestations of COVID-19 in the ED. Methods: This prospective diagnostic accuracy study was conducted at the ED of our non-academic level 1 trauma centre (Isala, Zwolle, the Netherlands). Patients were enrolled between 14 April and 22 April 2020. Patients (aged ≥16 years) with suspected COVID-19 presenting to the ED underwent POCUS. All patients received current standard of care, including PCR (naso-oropharyngeal swab). Outcome of POCUS was compared with PCR or CT scan outcome to determine diagnostic accuracy. Diagnostic accuracy measures were calculated using 2×2 contingency tables. Results: 100 patients were eligible to participate in this study, data of 93 patients were analysed. 27 (29%) patients were found positive for COVID-19 by PCR or CT. POCUS had a sensitivity of 89% (95% CI 70% to 97%), specificity of 59% (95% CI 46% to 71%), negative predictive value of 93% (95% CI 79% to 98%) and positive predictive value of 47% (95% CI 33% to 61%). In a subgroup of patients without previous cardiopulmonary disease (n=37), POCUS had a sensitivity of 100% (95% CI 70% to 100%), specificity of 76% (95% CI 54% to 90%), negative predictive value of 100% (95% CI 79% to 100%) and positive predictive value of 67% (95% CI 41% to 86%). Conclusion: POCUS of the lungs could serve as a valuable, radiation-free tool for excluding pulmonary manifestations of COVID-19 in patients in the ED at the point of assessment, especially in patients without previous cardiopulmonary disease. Trial Registration: Dutch Trial Register, No: NTR8544. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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