scholarly journals Comparing lung ultrasound: extensive versus short in COVID-19 (CLUES): a multicentre, observational study at the emergency department

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048795
Author(s):  
Bram Kok ◽  
Frederik Schuit ◽  
Arthur Lieveld ◽  
Kaoutar Azijli ◽  
Prabath WB Nanayakkara ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Diagnostic Accuracy ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Final Diagnosis ◽  
Likelihood Ratios ◽  
Reverse Transcription Pcr ◽  
Registration Number ◽  
Sensitivity Specificity

BackgroundBedside lung ultrasound (LUS) is an affordable diagnostic tool that could contribute to identifying COVID-19 pneumonia. Different LUS protocols are currently used at the emergency department (ED) and there is a need to know their diagnostic accuracy.DesignA multicentre, prospective, observational study, to compare the diagnostic accuracy of three commonly used LUS protocols in identifying COVID-19 pneumonia at the ED.Setting/patientsAdult patients with suspected COVID-19 at the ED, in whom we prospectively performed 12-zone LUS and SARS-CoV-2 reverse transcription PCR.MeasurementsWe assessed diagnostic accuracy for three different ultrasound protocols using both PCR and final diagnosis as a reference standard.ResultsBetween 19 March 2020 and 4 May 2020, 202 patients were included. Sensitivity, specificity and negative predictive value compared with PCR for 12-zone LUS were 91.4% (95% CI 84.4 to 96.0), 83.5% (95% CI 74.6 to 90.3) and 90.0% (95% CI 82.7 to 94.4). For 8-zone and 6-zone protocols, these results were 79.7 (95% CI 69.9 to 87.6), 69.0% (95% CI 59.6 to 77.4) and 81.3% (95% CI 73.8 to 87.0) versus 89.9% (95% CI 81.7 to 95.3), 57.5% (95% CI 47.9 to 66.8) and 87.8% (95% CI 79.2 to 93.2). Negative likelihood ratios for 12, 8 and 6 zones were 0.1, 0.3 and 0.2, respectively. Compared with the final diagnosis specificity increased to 83.5% (95% CI 74.6 to 90.3), 78.4% (95% CI 68.8 to 86.1) and 65.0% (95% CI 54.6 to 74.4), respectively, while the negative likelihood ratios were 0.1, 0.2 and 0.16.ConclusionIdentifying COVID-19 pneumonia at the ED can be aided by bedside LUS. The more efficient 6-zone protocol is an excellent screening tool, while the 12-zone protocol is more specific and gives a general impression on lung involvement.Trial registration numberNL8497.

scholarly journals B-Line Artifact as a Diagnostic Tool in Various Conditions at the Emergency Department

2021 ◽  
Vol 9 (E) ◽  
pp. 369-372
Author(s):  
Kamonwon Ienghong ◽  
Takaaki Suzuki ◽  
Ismet Celebi ◽  
Vajarabhongsa Bhudhisawasdi ◽  
Somsak Tiamkao ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Pulmonary Edema ◽  
Lung Ultrasound ◽  
Final Diagnosis ◽  
Diagnostic Study ◽  
Lung Pathology ◽  
Good Sensitivity ◽  
Emergency Patients ◽  
Pneumonia Diagnosis

BACKGROUND: B-line artifacts (BLAs) play an important role in identifying lung pathology. They may indicate different diseases. However, the diagnostic study of BLA as applied to emergency patients has not been well studied. AIM: The aim of this study was to determine the diagnostic accuracy of BLA in various conditions. METHODS: This was a retrospective observational study of emergency patients who had received lung ultrasound at Srinagarind Hospital’s Emergency Department throughout January 2020–December 2020. Ultrasound artifacts were recorded. Ultrasonography findings were correlated with final diagnosis. Sensitivity and specificity were also calculated. RESULTS: A total of 105 patients were evaluated. The most prevalent condition which BLA found in this study was pulmonary edema (44.12%) with 88.24% sensitivity and 46.48% specificity. BLA also indicated pneumonia with 66.67% sensitivity and 35.71% specificity. Diffuse BLA indicated pulmonary edema with 70% sensitivity and 70.42% specificity. Focal BLA indicated pneumonia with 28.57% sensitivity and 76.19% specificity. CONCLUSIONS: The sensitivity of BLA for pulmonary edema and pneumonia diagnosis in this study was of moderate to good sensitivity, but low specificity. BLA may become crucial in the diagnosis of lung pathology in the emergency department.

Prospective observational study of point-of-care ultrasound for diagnosing pneumonia

2018 ◽  
Vol 104 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Claire Lissaman ◽  
Panida Kanjanauptom ◽  
Cyril Ong ◽  
Mark Tessaro ◽  
Elliot Long ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Final Diagnosis ◽  
Point Of Care Ultrasound ◽  
Antibiotic Overuse ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Registration Number

ObjectivesThe clinical diagnosis of pneumonia lacks specificity and may lead to antibiotic overuse, whereas radiological diagnoses can lack sensitivity. Point-of-care lung ultrasound is an emerging diagnostic tool. There are limited prospective data, however, on the accuracy of sonologists in the paediatric emergency department setting. We aimed to test the diagnostic accuracy of lung ultrasound for pneumonia using chest radiograph (CR) as the reference standard.MethodsThis prospective observational cohort study in a paediatric emergency department enrolled children aged 1 month to <18 years, who had a CR ordered for possible pneumonia. Lung ultrasounds were performed by two blinded sonologists with focused training. Sonographic pneumonia was defined as lung consolidation with air bronchograms. Radiograph and ultrasound results both required agreement between two readers, with final results determined by an arbiter in cases of disagreement. Patient management was decided by treating clinicians who were blinded to lung ultrasound results. Follow-up was performed by phone and medical record review to obtain final diagnosis and antibiotic use.ResultsOf 97 included patients, CR was positive for pneumonia in 44/97 (45%) and lung ultrasound was positive in 57/97 (59%). Ultrasound sensitivity was 91% (95% CI 78% to 98%) and specificity was 68% (95% CI 54% to 80%). Ultrasound results displayed greater consistency with CR and patient outcomes when sonographic consolidation exceeded 1 cm. Thirteen of 57 patients with sonographic consolidation improved without antibiotics.ConclusionLung ultrasound may have a role as first-line imaging in patients with possible pneumonia, with higher specificity for consolidations exceeding 1 cm.Trial registration numberACTRN12616000361404, http://www.ANZCTR.org.au/ACTRN12616000361404.aspx

scholarly journals Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study

2020 ◽  
Vol 6 (4) ◽  
pp. 00539-2020
Author(s):  
Arthur W.E. Lieveld ◽  
Bram Kok ◽  
Frederik H. Schuit ◽  
Kaoutar Azijli ◽  
Jarom Heijmans ◽  
...  
Keyword(s):  
Observational Study ◽  
Diagnostic Accuracy ◽  
Prospective Observational Study ◽  
Operating Characteristic ◽  
Interobserver Agreement ◽  
Lung Ultrasound ◽  
False Negative ◽  
Negative Likelihood Ratio ◽  
Supplemental Oxygen ◽  
High Prevalence

BackgroundIn this coronavirus disease 2019 (COVID-19) pandemic, fast and accurate testing is needed to profile patients at the emergency department (ED) and efficiently allocate resources. Chest imaging has been considered in COVID-19 workup, but evidence on lung ultrasound (LUS) is sparse. We therefore aimed to assess and compare the diagnostic accuracy of LUS and computed tomography (CT) in suspected COVID-19 patients.MethodsThis multicentre, prospective, observational study included adult patients with suspected COVID-19 referred to internal medicine at the ED. We calculated diagnostic accuracy measures for LUS and CT using both PCR and multidisciplinary team (MDT) diagnosis as reference. We also assessed agreement between LUS and CT, and between sonographers.ResultsOne hundred and eighty-seven patients were recruited between March 19 and May 4, 2020. Area under the receiver operating characteristic (AUROC) was 0.81 (95% CI 0.75–0.88) for LUS and 0.89 (95% CI 0.84–0.94) for CT. Sensitivity and specificity for LUS were 91.9% (95% CI 84.0–96.7) and 71.0% (95% CI 61.1–79.6), respectively, versus 88.4% (95% CI 79.7–94.3) and 82.0% (95% CI 73.1–89.0) for CT. Negative likelihood ratio was 0.1 (95% CI 0.06–0.24) for LUS and 0.14 (95% CI 0.08–0.3) for CT. No patient with a false negative LUS required supplemental oxygen or admission. LUS specificity increased to 80% (95% CI 69.9–87.9) compared to MDT diagnosis, with an AUROC of 0.85 (95% CI 0.79–0.91). Agreement between LUS and CT was 0.65. Interobserver agreement for LUS was good: 0.89 (95% CI 0.83–0.93).ConclusionLUS and CT have comparable diagnostic accuracy for COVID-19 pneumonia. LUS can safely exclude clinically relevant COVID-19 pneumonia and may aid COVID-19 diagnosis in high prevalence situations.

Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

2020 ◽  
pp. 1-15
Author(s):  
Ling-Yu Guo ◽  
Phyllis Schneider ◽  
William Harrison
Keyword(s):  
Diagnostic Accuracy ◽  
Psychometric Properties ◽  
Language Impairment ◽  
Reference Data ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Criterion Validity ◽  
Likelihood Ratios ◽  
Generation Task ◽  
Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

scholarly journals What are the barriers to the completion of a home-based rehabilitation programme for patients awaiting surgery for lung cancer: a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041907
Author(s):  
Heloise Catho ◽  
Sebastien Guigard ◽  
Anne-Claire Toffart ◽  
Gil Frey ◽  
Thibaut Chollier ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Home Based ◽  
Registration Number

ObjectivesHome-based rehabilitation programmes (H-RPs) could facilitate the implementation of pulmonary rehabilitation prior to resection for non-small cell lung cancer (NSCLC), but their feasibility has not been evaluated. The aim of this study was to identify determinants of non-completion of an H-RP and the factors associated with medical events occurring 30 days after hospital discharge.DesignA prospective observational study.InterventionAll patients with confirmed or suspected NSCLC were enrolled in a four-component H-RP prior to surgery: (i) smoking cessation, (ii) nutritional support, (iii) physiotherapy (at least one session/week) and (iv) home cycle-ergometry (at least three times/week).OutcomesThe H-RP was defined as ‘completed’ if the four components were performed before surgery.ResultsOut of 50 patients included, 42 underwent surgery (80% men; median age: 69 (IQR 25%–75%; 60–74) years; 64% Chronic Obstructive Pulmonary Disease (COPD); 29% type 2 diabetes). Twenty patients (48%) completed 100% of the programme. The median (IQR) duration of the H-RP was 32 (19; 46) days. Multivariate analysis showed polypharmacy (n=24) OR=12.2 (95% CI 2.0 to 74.2), living alone (n=8) (single vs couple) OR=21.5 (95% CI 1.4 to >100) and a long delay before starting the H-RP (n=18) OR=6.24 (95% CI 1.1 to 36.6) were independently associated with a risk of non-completion. In univariate analyses, factors associated with medical events at 30 days were H-RP non-completion, diabetes, polypharmacy, social precariousness and female sex.ConclusionFacing multiple comorbidities, living alone and a long delay before starting the rehabilitation increase the risk of not completing preoperative H-RP.Trial registration numberNCT03530059.

scholarly journals Evaluation of Cystic and Solid Renal Lesions with Contrast-Enhanced Ultrasound: A Retrospective Study

2021 ◽  
Vol 07 (01) ◽  
pp. E25-E34
Author(s):  
Arash Najafi ◽  
Michael Wildt ◽  
Nicolin Hainc ◽  
Joachim Hohmann
Keyword(s):  
Final Diagnosis ◽  
Cystic Lesions ◽  
Likelihood Ratios ◽  
Renal Lesions ◽  
Contrast Enhanced ◽  
Potentially Malignant ◽  
Sensitivity Specificity ◽  
Solid Lesions ◽  
Conclusive Diagnosis

Abstract Purpose Renal lesions are frequent random findings on CT, MRI, and conventional ultrasound. Since they are usually found accidentally, the respective examinations have not been performed optimally to provide a conclusive diagnosis, making additional multiphase contrast-enhanced examinations necessary. The aim of the study is to correlate CEUS findings with the final diagnosis and to determine whether it is a suitable method for the conclusive characterization of undetermined renal lesions. Materials and Methods All CEUS examinations of focal renal lesions performed at our institute between 2007 and 2014 were retrospectively examined. 437 patients with a total of 491 lesions and 543 examinations were included. 54 patients had bilateral lesions. One patient had three lesions in one kidney. Histology was available in 49 cases and follow-ups in 124 cases. The sensitivity, specificity, positive and negative predictive value as well as positive and negative likelihood ratios were calculated. Results There were 54 malignant and 437 benign lesions. The sensitivity and specificity were 0.981/0.954 overall, 1.000/0.956 for cystic lesions, 0.977/0.906 for solid lesions, and 0.971/0.071 for the histologically confirmed lesions. Bosniak classification was consistent in 289 of 301 lesions (96%). Only 12 lesions (3.9%) were falsely assessed as malignant. Conclusion CEUS is an appropriate method for the clarification of undetermined renal lesions. The characterization of cystic lesions according to Bosniak is adequately possible, especially for potentially malignant lesions (types III and IV).

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