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

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

Emergency Medicine Journal ◽

10.1136/emermed-2020-210125 ◽

2020 ◽

pp. emermed-2020-210125

Author(s):

Svenja L Haak ◽

Iris JE Renken ◽

L Cara Jager ◽

Heleen Lameijer ◽

Brigitta (Britt) YM van der Kolk

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Point Of Care ◽

Trauma Centre ◽

Point Of Care Ultrasound ◽

Current Standard ◽

Cardiopulmonary Disease ◽

Pulmonary Manifestations

BackgroundA 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.MethodsThis 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.Results100 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%).ConclusionPOCUS 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 registrationDutch Trial Register, No: NTR8544.

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Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis

Emergency Medicine Journal ◽

10.1136/emermed-2020-209887 ◽

2020 ◽

pp. emermed-2020-209887

Author(s):

Georgios Alexandridis ◽

Eva W Verschuuren ◽

Arthur V Rosendaal ◽

Danny A Kanhai

Keyword(s):

Head Injury ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Point Of Care ◽

Risk Of Bias ◽

Cochrane Library ◽

Point Of Care Ultrasound ◽

Skull Fractures ◽

Fractures In Children

BackgroundBlunt head trauma is a common presentation to emergency departments (EDs). Identifying skull fractures in children is important as they are known factor of risk for traumatic brain injury (TBI). Currently, CT is the reference standard for diagnosing skull fractures and TBIs in children. Identifying skull fractures with point-of-care ultrasound (POCUS) may help risk-stratify children for TBI following blunt trauma. The purpose of this study is to evaluate the sensitivity, specificity, positive predictive value and negative predictive value of POCUS in identifying skull fractures in children.MethodsA systematic search was performed on 17 July 2020 in Ovid Medline, Cochrane Library, Google Scholar, Web of Science and Embase. Prospective studies reporting skull fractures diagnosed with ultrasound in children younger than 18 years due to blunt head injury were included. Studies that did not confirm the fracture with CT were excluded. The quality of studies was evaluated using the QUADAS-2 tool. Data were extracted from the eligible studies to calculate outcomes such as sensitivity and specificity; when possible overall outcomes were calculated.ResultsSeven studies were included. All eligible studies included patients for whom the decision to perform a CT scan was made in advance. Overall, the included studies demonstrated low risk of bias or had minor concerns regarding risk of bias. The pooled data (n=925) demonstrated a sensitivity of 91%, specificity of 96%, positive predictive value of 88% and negative predictive value of 97%.ConclusionThe included studies demonstrate minor methodological limitations. Overall, the evidence suggests that POCUS is a valid option for diagnosing skull fractures in children visiting the ED after blunt head injury.

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Signs and lines in lung ultrasound

Journal of Ultrasonography ◽

10.15557/jou.2021.0036 ◽

2021 ◽

Vol 21 (86) ◽

pp. e225-e233

Author(s):

Rohit Bhoil ◽

◽

Ajay Ahluwalia ◽

Rajesh Chopra ◽

Mukesh Surya ◽

...

Keyword(s):

Critical Care ◽

Pleural Effusion ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Colour Doppler ◽

Lung Density ◽

Pathological Conditions ◽

B Lines ◽

Lung Point

Point-of-care ultrasound has become firmly established in acute and critical care settings, and is now increasingly being used as an important tool in the assessment of the lungs. In this article, we briefly describe the technique of lung ultrasound and the various lines and signs commonly encountered during sonography of the lung, namely the normally visualised A- and T-lines and the bat sign, sliding sign (power slide sign on colour Doppler), sea-shore sign, curtain sign, and the lung pulse. We have also described signs seen in various pathological conditions like B-lines seen in cases of increased lung density; the quad sign, sinusoid sign, thoracic spine sign, plankton sign and the jelly fish sign seen in pleural effusion; the stratosphere sign and the lung point sign seen in pneumothorax; the shred/fractal sign and tissue-like sign in consolidation, and the double lung point sign seen in transient tachypnoea of the newborn. With adequate and appropriate training, lung ultrasound can be effectively utilised as a pointof-care investigation.

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LO074: Point of care ultrasound for lung B-lines in the early diagnosis of acute decompensated heart failure in the emergency department: a systematic review

CJEM ◽

10.1017/cem.2016.111 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S55-S55

Author(s):

K. McGivery ◽

P.R. Atkinson ◽

D. Lewis ◽

L. Taylor ◽

K. Gadd

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Emergency Department ◽

Likelihood Ratio ◽

Lung Ultrasound ◽

Acute Decompensated Heart Failure ◽

Point Of Care ◽

Decompensated Heart Failure ◽

Point Of Care Ultrasound ◽

B Lines

Introduction: Dyspnea is a common presenting problem in the emergency department (ED) that frequently creates a diagnostic challenge for physicians. Acute decompensated heart failure (ADHF) represents a common cause that requires prompt diagnosis and management. Recent studies on dyspneic patients have suggested a potential role for point-of-care ultrasound (PoCUS). The objective of this systematic review was to assess the sensitivity and specificity of early bedside lung ultrasound in patients presenting to the ED with dyspnea. Methods: A search of the literature was conducted using PubMed, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conferences. We included prospective studies that assessed the diagnostic accuracy of B-lines from bedside lung ultrasound in the ED patients compared to a clinical diagnosis of ADHF at hospital discharge. The final diagnosis included at least one of CXR, computed tomography, or BNP. Two reviewers independently screened all titles and abstracts for possible inclusions. Two separate content experts full text-reviewed selected studies and performed quality analysis using a modified Critical Appraisal Skills Program (CASP) questionnaire. Extracted data was assessed with summary receiver operator characteristics curve (SROC) analysis with pooled sensitivity and specificity. Heterogenity was tested. Results: The electronic search yielded 3674 articles of which six met the inclusion criteria and fulfilled CASP requirements for methodological quality. The total number of patients in these studies was 1911. Heterogeneity was noted; due to poorer performance by novice users. Meta-analysis of the data showed that in detecting ADHF, bedside lung ultrasound had a pooled sensitivity of 89.6% (95% CI 69.5 to 97.0%) and a pooled specificity of 88.4% (95% CI 75.0 to 95.1%). The positive likelihood ratio was 6.01 (95% CI 2.93 to 12.32) and negative likelihood ratio was 0.13 (95% CI 0.06 to 0.30). Conclusion: This study suggests that in patients presenting to the ED with undifferentiated dyspnea, early point of care lung ultrasound may be used to confirm the diagnosis of ADHF, which may facilitate earlier appropriate management. Test performance may vary according to experience.

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Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽

10.1186/s13054-020-03369-5 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Arif Hussain ◽

Gabriele Via ◽

Lawrence Melniker ◽

Alberto Goffi ◽

Guido Tavazzi ◽

...

Keyword(s):

Lung Ultrasound ◽

Expert Panel ◽

Point Of Care ◽

Expert Consensus ◽

Future Research ◽

Point Of Care Ultrasound ◽

The Past ◽

Modified Delphi ◽

Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

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Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01396-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stephanie-Susanne Stecher ◽

Sofia Anton ◽

Alessia Fraccaroli ◽

Jeremias Götschke ◽

Hans Joachim Stemmler ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Lung Ultrasound ◽

Clinical Course ◽

Point Of Care ◽

Clinical Deterioration ◽

Normal Lung ◽

Icu Patients ◽

Standardized Protocol ◽

Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

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Interstitial syndrome-lung ultrasound B lines: a potential marker for pulmonary metastases? A case series

Italian Journal of Medicine ◽

10.4081/itjm.2018.1009 ◽

2018 ◽

Vol 12 (3) ◽

pp. 223-226 ◽

Cited By ~ 1

Author(s):

Maria Viviana Carlino ◽

Costantino Mancusi ◽

Giovanni De Simone ◽

Filomena Liccardi ◽

Mario Guarino ◽

...

Keyword(s):

Lung Ultrasound ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Point Of Care ◽

Case Series ◽

Point Of Care Ultrasound ◽

Interstitial Syndrome ◽

Potential Marker ◽

Bilateral Lung ◽

Enhanced Computed Tomography

Four patients presented to the Emergency Department with dyspnea and they underwent point-of-care ultrasound. Lung ultrasound showed a diffuse bilateral B-profile pattern-interstitial syndrome, they underwent contrast-enhanced computed tomography scan of thorax that showed multiple bilateral lung metastases. The detection, in a dyspneic patient, of a diffuse Bprofile pattern not attributable to traditional interstitial syndrome conditions (pulmonary fibrosis, acute respiratory distress syndrome, acute pulmonary edema, interstitial pneumonia) could be indicative of multiple pulmonary metastases.

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The Role of Lung Ultrasound Before and During the COVID-19 Pandemic: A review article

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211006122842 ◽

2021 ◽

Vol 17 ◽

Author(s):

Mustafa J. Musa ◽

Mohamed Yousef ◽

Mohammed Adam ◽

Awadalla Wagealla ◽

Lubna Boshara ◽

...

Keyword(s):

Lung Ultrasound ◽

Point Of Care ◽

Power Doppler ◽

Doppler Imaging ◽

Point Of Care Ultrasound ◽

Institute Of Medicine ◽

Pubmed Central ◽

Contrast Enhanced ◽

Ultrasound Findings

: Lung ultrasound [LUS] has evolved considerably over the last years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of [LUS] and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted including the national library of medicine, and the national institute of medicine, PubMed Central [PMC] to identify the articles depended on [LUS] to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the pandemic [11], clinical articles before COVID-19 [14], review studies during the pandemic [27], clinical cases during the pandemic [5] and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of [LUS] for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.

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Diagnostic accuracy of point-of-care knee ultrasound for evaluation of meniscus and collateral ligaments pathology in comparison with MRI

Acta Radiologica ◽

10.1177/02841851211058280 ◽

2021 ◽

pp. 028418512110582

Author(s):

Ahmed Elshimy ◽

Ahmed M Osman ◽

Mohamed El Sayed Awad ◽

Mohamed M Abdel Aziz

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Point Of Care ◽

Operative Procedure ◽

Point Of Care Ultrasound ◽

Collateral Ligaments ◽

Collateral Ligament ◽

Diagnostic Modality ◽

Cross Sectional ◽

Portable Ultrasonography

Background Although magnetic resonance imaging (MRI) is often the “gold standard” for diagnosing knee problems, it has many limitations. Therefore, ultrasonography has been suggested as an effective rapid alternative in many knee abnormalities, especially after injuries of the meniscus and collateral ligaments. Purpose To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) in detecting injuries of the meniscus and collateral ligament compared to MRI. Material and Methods An observational cross-sectional blinded study was conducted of 60 patients with clinically suspicious meniscus and collateral ligament injuries who were planned for an arthroscopy and or operative procedure. These patients underwent both blinded POCUS and MRI of the knees before the intervention procedure and results of both imaging modalities were compared according to the operative and arthroscopic findings. Results The preoperative reliability of POCUS compared to MRI for the assessment of meniscus injuries was sensitivity (92.9% vs. 90.5%), specificity (88.9% vs. 83.3%), positive predictive value (PPV; 95.1% vs. 92.7%), negative predictive value (NPV; 84.2% vs. 79%), and overall accuracy (91.7% vs. 88.3%). However, for diagnosing collateral ligament injures, POCUS versus MRI assessed sensitivity (92.3% vs. 88.5%), specificity (100% vs. 97.1%), PPV (100% vs. 95.8%), NPV (94.4% vs. 91.7%), and overall accuracy (96.7% vs. 93.3%). Conclusion Ultrasonography is a useful screening tool for the initial diagnosis of meniscal and collateral ligament pathology compared to or even with potential advantages over MRI, especially when MRI is unavailable or contraindicated. As newly advanced portable ultrasonography becomes available, it could be considered as a point-of-injury diagnostic modality.

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Abstract 16244: Point of Care Ultrasound of the Jugular Venous Pulse in the Upright Position (u 2 Jvp) Predicts Elevated Right Atrial Pressure and Pulmonary Capillary Wedge Pressure on Right Heart Catheterization in Obese and Non-obese Patients

Circulation ◽

10.1161/circ.142.suppl_3.16244 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Libo Wang ◽

Jonathan Harrison ◽

Elizabeth Dranow ◽

Lillian Khor

Keyword(s):

Heart Failure ◽

Predictive Value ◽

Point Of Care ◽

Right Heart Catheterization ◽

Upright Position ◽

Right Atrial ◽

Heart Catheterization ◽

Point Of Care Ultrasound ◽

Right Heart ◽

Clinically Significant

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. The visual inspection of jugular venous pulsation (JVP) in a reclined position and measuring its height from the sternal notch has been used as a surrogate for right atrial pressure (RAP). There are no studies on the predictive value of a visible internal jugular vein (IJV) in the upright position (U 2 JVP). Hypothesis: Point of care ultrasound (POCUS) for volume assessment in the upright position is predictive of clinically significant hypervolemia. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV and its size in comparison to the carotid artery was identified on ultrasound with the patient upright. Elevated RAP and PCWP was present if the IJV was still visible and not collapsed throughout the entirety of the respiratory cycle. Valsalva was used to confirm the position of a collapsed IJV. Results: 72 participants underwent U 2 JVP assessment on the same day prior to RHC. Average BMI was 31.9 kg/m2. The area under the curve (AUC) of U 2 JVP predicting RAP greater than 10 mmHg and PCWP of 15 mmhg or higher on RHC was 0.78 (95% CI 0.66-0.9, p<0.001), with AUC of 0.86 and 0.74 for non-obese and obese subgroups respectively, p= 0.38. The finding of a visible U 2 JVP in the upright position was 70.6 % sensitive and 85.5 % specific with a negative predictive value of 90.4% for identifying both RAP greater than 10 mmHg and PCWP equal or greater than 15 mmHg. Conclusions: The U 2 JVP is novel and pragmatic bed-side approach to the assessment of clinically significant elevated intra-cardiac pressures in our increasingly obese heart failure population.

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