急诊中应用肺部超声排除 COVID-19 肺炎的多中心前瞻性敏感性研究。

Lung ultrasound in ruling out COVID-19 pneumonia in the ED: a multicentre prospective sensitivity study.

机构信息

Department of Emergency Medicine, Trieste University Integrated Healthcare Company, Trieste, Friuli-Venezia Giulia, Italy.

Department of Emergency Medicine, University of Verona, Verona, Veneto, Italy.

出版信息

Emerg Med J. 2022 Mar;39(3):199-205. doi: 10.1136/emermed-2020-210973. Epub 2021 Dec 22.

DOI:10.1136/emermed-2020-210973

PMID:34937709

Abstract

PURPOSE

Early diagnosis of COVID-19 has a crucial role in confining the spread among the population. Lung ultrasound (LUS) was included in the diagnostic pathway for its high sensitivity, low costs, non-invasiveness and safety. We aimed to test the sensitivity of LUS to rule out COVID-19 pneumonia (COVIDp) in a population of patients with suggestive symptoms.

METHODS

Multicentre prospective observational study in three EDs in Northeastern Italy during the first COVID-19 outbreak. A convenience sample of 235 patients admitted to the ED for symptoms suggestive COVIDp (fever, cough or shortness of breath) from 17 March 2020 to 26 April 2020 was enrolled. All patients underwent a sequential assessment involving: clinical examination, LUS, CXR and arterial blood gas. The index test under investigation was a standardised protocol of LUS compared with a pragmatic composite reference standard constituted by: clinical gestalt, real-time PCR test, radiological and blood gas results. Of the 235 enrolled patients, 90 were diagnosed with COVIDp according to the reference standard.

RESULTS

Among the patients with suspected COVIDp, the prevalence of SARS-CoV-2 was 38.3%. The sensitivity of LUS for diagnosing COVIDp was 85.6% (95% CI 76.6% to 92.1%); the specificity was 91.7% (95% CI 86.0% to 95.7%). The positive predictive value and the negative predictive value were 86.5% (95%CI 78.8% to 91.7%) and 91.1% (95% CI 86.1% to 94.4%) respectively. The diagnostic accuracy of LUS for COVIDp was 89.4% (95% CI 84.7% to 93.0%). The positive likelihood ratio was 10.3 (95% CI 6.0 to 17.9), and the negative likelihood ratio was 0.16 (95% CI 0.1 to 0.3).

CONCLUSION

In a population with high SARS-CoV-2 prevalence, LUS has a high sensitivity (and negative predictive value) enough to rule out COVIDp in patients with suggestive symptoms. The role of LUS in diagnosing patients with COVIDp is perhaps even more promising. Nevertheless, further research with adequately powered studies is needed.

TRIAL REGISTRATION NUMBER

NCT04370275.

摘要

目的

COVID-19 的早期诊断对于控制人群传播至关重要。由于其高灵敏度、低成本、非侵入性和安全性，肺部超声（LUS）已被纳入诊断途径。我们旨在测试 LUS 排除 COVID-19 肺炎（COVIDp）的敏感性，该研究纳入了有 COVIDp 症状的患者。

方法

这是一项在意大利东北部的三个急诊部进行的多中心前瞻性观察性研究。2020 年 3 月 17 日至 2020 年 4 月 26 日期间，对因 COVIDp 症状（发热、咳嗽或呼吸急促）而就诊的 235 名患者进行了便利样本入组。所有患者均接受了包括临床检查、LUS、CXR 和动脉血气分析的连续评估。研究中的指标测试是与实用综合参考标准（由临床整体情况、实时 PCR 测试、影像学和血气结果组成）比较的标准化 LUS 方案。在纳入的 235 名患者中，90 名根据参考标准诊断为 COVIDp。

结果

在疑似 COVIDp 的患者中，SARS-CoV-2 的患病率为 38.3%。LUS 诊断 COVIDp 的敏感性为 85.6%（95%CI 76.6%至 92.1%）；特异性为 91.7%（95%CI 86.0%至 95.7%）。阳性预测值和阴性预测值分别为 86.5%（95%CI 78.8%至 91.7%）和 91.1%（95%CI 86.1%至 94.4%）。LUS 对 COVIDp 的诊断准确性为 89.4%（95%CI 84.7%至 93.0%）。阳性似然比为 10.3（95%CI 6.0 至 17.9），阴性似然比为 0.16（95%CI 0.1 至 0.3）。