Infectious Diseases Service, University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Radiology, University Hospital and University of Lausanne, Lausanne, Switzerland.
Clin Infect Dis. 2021 Dec 6;73(11):e4189-e4196. doi: 10.1093/cid/ciaa1408.
Lung ultrasonography (LUS) is a promising pragmatic risk-stratification tool in coronavirus disease 2019 (COVID-19). This study describes and compares LUS characteristics between patients with different clinical outcomes.
Prospective observational study of polymerase chain reaction-confirmed adults with COVID-19 with symptoms of lower respiratory tract infection in the emergency department (ED) of Lausanne University Hospital. A trained physician recorded LUS images using a standardized protocol. Two experts reviewed images blinded to patient outcome. We describe and compare early LUS findings (≤24 hours of ED presentation) between patient groups based on their 7-day outcome (1) outpatients, (2) hospitalized, and (3) intubated/dead. Normalized LUS score was used to discriminate between groups.
Between 6 March and 3 April 2020, we included 80 patients (17 outpatients, 42 hospitalized, and 21 intubated/dead). Seventy-three patients (91%) had abnormal LUS (70% outpatients, 95% hospitalized, and 100% intubated/dead; P = .003). The proportion of involved zones was lower in outpatients compared with other groups (median [IQR], 30% [0-40%], 44% [31-70%], 70% [50-88%]; P < .001). Predominant abnormal patterns were bilateral and there was multifocal spread thickening of the pleura with pleural line irregularities (70%), confluent B lines (60%), and pathologic B lines (50%). Posterior inferior zones were more often affected. Median normalized LUS score had a good level of discrimination between outpatients and others with area under the ROC of .80 (95% CI, .68-.92).
Systematic LUS has potential as a reliable, cheap, and easy-to-use triage tool for the early risk stratification in patients with COVID-19 presenting to EDs.
肺部超声（LUS）是一种很有前途的 2019 冠状病毒病（COVID-19）实用风险分层工具。本研究描述并比较了不同临床结局患者的 LUS 特征。
前瞻性观察性研究，纳入洛桑大学医院急诊科（ED）因下呼吸道感染症状且经聚合酶链反应（PCR）确诊的成年 COVID-19 患者。一名经过培训的医生使用标准化方案记录 LUS 图像。两名专家在不了解患者结局的情况下对图像进行盲法评估。我们根据患者 7 天结局（1）门诊、（2）住院和（3）插管/死亡，描述并比较了早期 LUS 表现（ED 就诊后≤24 小时）。使用归一化 LUS 评分来区分各组。
在 2020 年 3 月 6 日至 4 月 3 日期间，共纳入 80 例患者（门诊患者 17 例，住院患者 42 例，插管/死亡患者 21 例）。73 例（91%）患者的 LUS 异常（门诊患者 70%，住院患者 95%，插管/死亡患者 100%；P=0.003）。与其他组相比，门诊患者受累区域的比例较低（中位数[四分位间距]，30%[0-40%]，44%[31-70%]，70%[50-88%]；P<0.001）。主要异常模式为双侧，胸膜不规则增厚伴多发胸膜线增厚（70%）、融合 B 线（60%）和病理性 B 线（50%）。后下区更常受累。归一化 LUS 评分中位数在区分门诊患者和其他患者方面具有良好的区分度，ROC 曲线下面积为 0.80（95%CI，0.68-0.92）。
系统 LUS 具有成为一种可靠、廉价且易于使用的分诊工具的潜力，可用于对急诊科就诊的 COVID-19 患者进行早期风险分层。
