Falgarone Géraldine, Pamoukdjian Frédéric, Cailhol Johann, Giocanti-Auregan Audrey, Guis Sandrine, Bousquet Guilhem, Bouchaud Olivier, Seror Olivier
Université Sorbonne Paris Nord, INSERM UMR_S942, Bobigny F-93009, Paris, France.
AP-HP, Hôpital Avicenne, Unité de Médecine Ambulatoire (UMA), Bobigny F-93009, Paris, France.
Aging (Albany NY). 2020 Oct 30;12(20):19945-19953. doi: 10.18632/aging.104150.
COVID-19 pneumonia can be severe, with an unpredictable evolution and high mortality prevalence in older patients. The diagnosis is usually performed by RT-PCR or CT chest scan. Lung ultrasonography (LUS) has been proposed as an alternative method to monitor patients with COVID-19 pneumonia. To assess the diagnostic performance of LUS, we performed LUS using a portable device and adapting a protocol already used in Acute Respiratory Syndrome. We used the score obtained with the index we created to assess for LUS diagnostic performance as compared to lung CT chest scan and to predict for oxygen requirements. Daily bedside LUS was easy to perform and microbiologically safe. LUS was 89% sensitive and 100% specific in predicting CT chest scan abnormalities, and 95% sensitive and 67% specific in detecting oxygen requirements. This is the first report on the diagnostic performance of LUS as compared to CT chest scan for the diagnosis of COVID-19 pneumonia and assessments of oxygen requirements by LUS. LUS could help in the orientation of dyspneic patients to intensive care. It could also be proposed when there is limited access to CT scan in the context of a pandemic crisis, or to implement clinical lung examinations for outpatient follow-up.
新型冠状病毒肺炎(COVID-19肺炎)可能较为严重,其病情发展难以预测,老年患者的死亡率较高。诊断通常通过逆转录聚合酶链反应(RT-PCR)或胸部CT扫描进行。肺超声检查(LUS)已被提议作为监测COVID-19肺炎患者的一种替代方法。为了评估LUS的诊断性能,我们使用便携式设备并采用一种已在急性呼吸综合征中使用的方案进行LUS检查。我们使用通过创建的指数获得的分数来评估LUS的诊断性能,并与胸部CT扫描进行比较,同时预测氧气需求。每日床边LUS操作简便且微生物学上安全。LUS在预测胸部CT扫描异常方面的敏感性为89%,特异性为100%;在检测氧气需求方面的敏感性为95%,特异性为67%。这是首篇关于LUS与CT扫描相比在诊断COVID-19肺炎以及通过LUS评估氧气需求方面的诊断性能报告。LUS有助于指导呼吸困难患者进入重症监护病房。在大流行危机期间CT扫描受限的情况下,或者为门诊随访进行临床肺部检查时,也可以采用LUS。