Department of Emergency Medicine, University Hospital of Angers, Angers, France.
UNIV Angers, UMR MitoVasc CNRS 6215 INSERM 1083, Angers, France.
PLoS One. 2023 Apr 26;18(4):e0284748. doi: 10.1371/journal.pone.0284748. eCollection 2023.
Lung point-of-care ultrasonography (L-POCUS) is highly effective in detecting pulmonary peripheral patterns and may allow early identification of patients who are likely to develop an acute respiratory distress syndrome (ARDS). We hypothesized that L-POCUS performed within the first 48 hours of non-critical patients with suspected COVID-19 would identify those with a high-risk of worsening.
POCUSCO was a prospective, multicenter study. Non-critical adult patients who presented to the emergency department (ED) for suspected or confirmed COVID-19 were included and had L-POCUS performed within 48 hours following ED presentation. The lung damage severity was assessed using a previously developed score reflecting both the extension and the intensity of lung damage. The primary outcome was the rate of patients requiring intubation or who died within 14 days following inclusion.
Among 296 patients, 8 (2.7%) met the primary outcome. The area under the curve (AUC) of L-POCUS was 0.80 [95%CI:0.60-0.94]. The score values which achieved a sensibility >95% in defining low-risk patients and a specificity >95% in defining high-risk patients were <1 and ≥16, respectively. The rate of patients with an unfavorable outcome was 0/95 (0%[95%CI:0-3.9]) for low-risk patients (score = 0), 4/184 (2.17%[95%CI:0.8-5.5]) for intermediate-risk patients (score 1-15) and 4/17 (23.5%[95%CI:11.4-42.4]) for high-risk patients (score ≥16). In confirmed COVID-19 patients (n = 58), the AUC of L-POCUS was 0.97 [95%CI:0.92-1.00].
L-POCUS performed within the first 48 hours following ED presentation allows risk-stratification of patients with non-severe COVID-19.
肺部床边超声（L-POCUS）在检测肺部外周模式方面非常有效，可能有助于早期识别可能发生急性呼吸窘迫综合征（ARDS）的患者。我们假设，对疑似 COVID-19 的非危重症患者在急诊科（ED）就诊后 48 小时内进行 L-POCUS 检查，可以识别出病情恶化风险较高的患者。
POCUSCO 是一项前瞻性、多中心研究。纳入在急诊科就诊疑似或确诊 COVID-19 的非危重症成年患者，并在 ED 就诊后 48 小时内进行 L-POCUS 检查。使用先前开发的反映肺部损伤程度和强度的评分来评估肺部损伤严重程度。主要结局是在纳入后 14 天内需要插管或死亡的患者比例。
在 296 例患者中，8 例（2.7%）达到了主要结局。L-POCUS 的曲线下面积（AUC）为 0.80 [95%CI：0.60-0.94]。在定义低危患者时，得分值达到敏感性>95%和定义高危患者时特异性>95%的分别是<1 和≥16。低危患者（评分=0）的不良预后发生率为 0/95（0%[95%CI：0-3.9]），中危患者（评分 1-15）的不良预后发生率为 4/184（2.17%[95%CI：0.8-5.5]），高危患者（评分≥16）的不良预后发生率为 4/17（23.5%[95%CI：11.4-42.4]）。在确诊 COVID-19 患者（n=58）中，L-POCUS 的 AUC 为 0.97 [95%CI：0.92-1.00]。
在 ED 就诊后 48 小时内进行 L-POCUS 检查可对非重症 COVID-19 患者进行风险分层。
