Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Quantitative Sciences Unit, Stanford University, Stanford, California, USA.
J Ultrasound Med. 2021 Nov;40(11):2369-2376. doi: 10.1002/jum.15620. Epub 2021 Jan 11.
Lung ultrasound (LUS) has received considerable interest in the clinical evaluation of patients with COVID-19. Previously described LUS manifestations for COVID-19 include B-lines, consolidations, and pleural thickening. The interrater reliability (IRR) of these findings for COVID-19 is unknown.
This study was conducted between March and June 2020. Nine physicians (hospitalists: n = 4; emergency medicine: n = 5) from 3 medical centers independently evaluated n = 20 LUS scans (n = 180 independent observations) collected from patients with COVID-19, diagnosed via RT-PCR. These studies were randomly selected from an image database consisting of COVID-19 patients evaluated in the emergency department with portable ultrasound devices. Physicians were blinded to any patient information or previous LUS interpretation. Kappa values (κ) were used to calculate IRR.
There was substantial IRR on the following items: normal LUS scan (κ = 0.79 [95% CI: 0.72-0.87]), presence of B-lines (κ = 0.79 [95% CI: 0.72-0.87]), ≥3 B-lines observed (κ = 0.72 [95% CI: 0.64-0.79]). Moderate IRR was observed for the presence of any consolidation (κ = 0.57 [95% CI: 0.50-0.64]), subpleural consolidation (κ = 0.49 [95% CI: 0.42-0.56]), and presence of effusion (κ = 0.49 [95% CI: 0.41-0.56]). Fair IRR was observed for pleural thickening (κ = 0.23 [95% CI: 0.15-0.30]).
Many LUS manifestations for COVID-19 appear to have moderate to substantial IRR across providers from multiple specialties utilizing differing portable devices. The most reliable LUS findings with COVID-19 may include the presence/count of B-lines or determining if a scan is normal. Clinical protocols for LUS with COVID-19 may require additional observers for the confirmation of less reliable findings such as consolidations.
肺部超声（LUS）在 COVID-19 患者的临床评估中受到了广泛关注。先前描述的 COVID-19 的 LUS 表现包括 B 线、实变和胸膜增厚。这些发现对于 COVID-19 的观察者间可靠性（IRR）尚不清楚。
本研究于 2020 年 3 月至 6 月进行。来自 3 家医疗中心的 9 名医生（医院医生：n=4；急诊医生：n=5）独立评估了 n=20 例 COVID-19 患者的 LUS 扫描（n=180 个独立观察），这些患者通过 RT-PCR 诊断。这些研究是从由急诊科使用便携式超声设备评估的 COVID-19 患者的图像数据库中随机选择的。医生对任何患者信息或先前的 LUS 解释均不知情。Kappa 值（κ）用于计算 IRR。
在以下项目中存在显著的观察者间可靠性：正常 LUS 扫描（κ=0.79 [95%CI：0.72-0.87]），存在 B 线（κ=0.79 [95%CI：0.72-0.87]），观察到≥3 条 B 线（κ=0.72 [95%CI：0.64-0.79]）。观察到存在任何实变（κ=0.57 [95%CI：0.50-0.64]）、胸膜下实变（κ=0.49 [95%CI：0.42-0.56]）和存在胸腔积液（κ=0.49 [95%CI：0.41-0.56]）的 IRR 为中度，胸膜增厚（κ=0.23 [95%CI：0.15-0.30]）的 IRR 为轻度。
来自多个专业的使用不同便携式设备的多位提供者对 COVID-19 的许多 LUS 表现均具有中度至显著的观察者间可靠性。COVID-19 最可靠的 LUS 发现可能包括 B 线的存在/数量或确定扫描是否正常。COVID-19 的 LUS 临床方案可能需要其他观察者来确认不太可靠的发现，例如实变。
