Fabuel Ortega Pablo, Almendros Lafuente Noelia, Cánovas García Sandra, Martínez Gálvez Laura, González-Vidal Aurora
Vistalegre-La Flota Health Centre, Paseo Ing. Sebastián Feringán, 18, 30007, Murcia, Spain.
Mario Spreáfico-Archena Health Centre, Archena, Murcia, Spain.
Ultrasound J. 2022 Feb 22;14(1):11. doi: 10.1186/s13089-022-00257-7.
The use of lung ultrasound (LU) with COVID-19 pneumonia patients should be validated in the field of primary care (PC). Our study aims to evaluate the correlation between LU and radiographic imaging in PC patients with suspected COVID-19 pneumonia.
This observational, prospective and multicentre study was carried out with patients from a PC health area whose tests for COVID-19 and suspected pneumonia had been positive and who then underwent LU and a digital tomosynthesis (DT). Four PC physicians obtained data regarding the patients' symptoms, examination, medical history and ultrasound data for 12 lung fields: the total amount of B lines (zero to four per field), the irregularity of the pleural line, subpleural consolidation, lung consolidation and pleural effusion. These data were subsequently correlated with the presence of pneumonia by means of DT, the need for hospital admission and a consultation in the hospital emergency department in the following 15 days.
The study was carried out between November 2020 and January 2021 with 70 patients (40 of whom had pneumonia, confirmed by means of DT). Those with pneumonia were older, had a higher proportion of arterial hypertension and lower oxygen saturation (sO). The number of B lines was higher in patients with pneumonia (16.53 vs. 4.3, p < 0.001). The area under the curve for LU was 0.87 (95% CI 0.78-0.96, p < 0.001), and when establishing a cut-off point of six B lines or more, the sensitivity was 0.875 (95% CI 0.77-0.98, p < 0.05), the specificity was 0.833 (95% CI 0.692-0.975, p < 0.05), the positive-likelihood ratio was 5.25 (95% CI 2.34-11.79, p < 0.05) and the negative-likelihood ratio was 0.15 (95% CI 0.07-0.34, p < 0.05). An age of ≥ 55 and a higher number of B lines were associated with admission. Patients who required admission (n = 7) met at least one of the following criteria: ≥ 55 years of age, sO ≤ 95%, presence of at least one subpleural consolidation or ≥ 21 B lines.
LU has great sensitivity and specificity for the diagnosis of COVID-19 pneumonia in PC. Clinical ultrasound findings, along with age and saturation, could, therefore, improve decision-making in this field.
在初级保健领域，应验证肺部超声（LU）在新型冠状病毒肺炎（COVID-19肺炎）患者中的应用。我们的研究旨在评估初级保健中疑似COVID-19肺炎患者的肺部超声与影像学检查之间的相关性。
本观察性、前瞻性多中心研究针对来自一个初级保健健康区域的患者开展，这些患者的COVID-19检测及疑似肺炎检测呈阳性，随后接受了肺部超声检查和数字断层合成（DT）检查。四位初级保健医生获取了患者的症状、检查、病史以及12个肺野的超声数据：B线总数（每个肺野0至4条）、胸膜线不规则情况、胸膜下实变、肺实变和胸腔积液。这些数据随后通过DT与肺炎的存在情况、住院需求以及接下来15天内医院急诊科的会诊需求进行相关性分析。
该研究于2020年11月至2021年1月期间进行，共纳入70例患者（其中40例经DT确诊为肺炎）。患有肺炎的患者年龄更大，动脉高血压比例更高，血氧饱和度（sO）更低。肺炎患者的B线数量更多（16.53对4.3，p<0.001）。肺部超声的曲线下面积为0.87（95%置信区间0.78 - 0.96，p<0.001），当设定B线数量为6条及以上的截断点时，敏感性为0.875（95%置信区间0.77 - 0.98，p<0.05），特异性为0.833（95%置信区间0.692 - 0.975，p<0.05），阳性似然比为5.25（95%置信区间2.34 - 11.79，p<0.05），阴性似然比为0.15（95%置信区间0.07 - 0.34，p<0.05）。年龄≥55岁和B线数量较多与住院相关。需要住院的患者（n = 7）至少符合以下标准之一：年龄≥55岁、sO≤95%、存在至少一处胸膜下实变或B线数量≥21条。
肺部超声对初级保健中COVID-19肺炎的诊断具有较高的敏感性和特异性。因此，临床超声检查结果以及年龄和血氧饱和度可改善该领域的决策。
