Emergency Department, Isala, Zwolle, the Netherlands.
Emergency Department, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
Emerg Med J. 2021 Feb;38(2):94-99. doi: 10.1136/emermed-2020-210125. Epub 2020 Nov 18.
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.
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.
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%).
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.
Dutch Trial Register, No: NTR8544.
在急诊科 (ED) 中，一种有前途的诊断 COVID-19 肺部表现的方法是即时护理超声 (POCUS)。目前使用的 PCR 以及胸部 X 光和 CT 扫描有重要的缺点。本研究的目的是评估 POCUS 在 ED 中疑似 COVID-19 肺部表现患者中的诊断准确性。
这项前瞻性诊断准确性研究在我们的非学术一级创伤中心 (Isala，Zwolle，荷兰) 的 ED 进行。患者于 2020 年 4 月 14 日至 4 月 22 日期间入组。疑似 COVID-19 并就诊于 ED 的患者接受 POCUS。所有患者均接受当前的标准护理，包括 PCR（鼻咽拭子）。通过比较 POCUS 结果与 PCR 或 CT 扫描结果来确定诊断准确性。使用 2×2 列联表计算诊断准确性测量值。
共有 100 名患者符合入组条件，对 93 名患者的数据进行了分析。27 名（29%）患者的 PCR 或 CT 检查结果为 COVID-19 阳性。POCUS 的灵敏度为 89%（95%CI 70%至 97%），特异性为 59%（95%CI 46%至 71%），阴性预测值为 93%（95%CI 79%至 98%），阳性预测值为 47%（95%CI 33%至 61%）。在无先前心肺疾病的患者亚组（n=37）中，POCUS 的灵敏度为 100%（95%CI 70%至 100%），特异性为 76%（95%CI 54%至 90%），阴性预测值为 100%（95%CI 79%至 100%），阳性预测值为 67%（95%CI 41%至 86%）。
POCUS 肺部检查可作为一种有价值的、无辐射的工具，用于在 ED 评估时排除 COVID-19 肺部表现，尤其是在无先前心肺疾病的患者中。
荷兰试验注册处，编号：NTR8544。
