Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center
Objectives Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening.Design, setting and participants This...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e060181.full |
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| author | Olivier Hugli Jean-Yves Meuwly Noémie Boillat-Blanco Pierre-Nicolas Carron Siméon Schaad Thomas Brahier Mary-Anne Hartley Jean-Baptiste Cordonnier Luca Bosso Tanguy Espejo Olivier Pantet |
| author_facet | Olivier Hugli Jean-Yves Meuwly Noémie Boillat-Blanco Pierre-Nicolas Carron Siméon Schaad Thomas Brahier Mary-Anne Hartley Jean-Baptiste Cordonnier Luca Bosso Tanguy Espejo Olivier Pantet |
| author_sort | Olivier Hugli |
| collection | DOAJ |
| description | Objectives Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening.Design, setting and participants This prospective observational cohort included adults presenting with cough and/or dyspnoea at a SARS-CoV-2 screening centre of Lausanne University Hospital between 31 March and 8 May 2020.Interventions Investigators recorded standardised LUS images and videos in 10 lung zones per patient. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to prespecified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVID-19 positive vs COVID-19 negative).Primary and secondary outcome measures We finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score.Results Of 134 included patients, 23% (n=30/134) were COVID-19 positive and 77% (n=103/134) were COVID-19 negative; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2–5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVID-19 positive compared with COVID-19 negative (45% vs 26%, p=0.045) and mostly consisted of focal pathologic B lines. Combining clinical findings in a multivariate logistic regression score had an area under the receiver operating curve of 80.3% to detect COVID-19, and slightly improved to 84.5% with the addition of LUS features.Conclusions COVID-19-positive patients are significantly more likely to have lung pathology by LUS. However, LUS has an insufficient sensitivity and is not an appropriate screening tool in outpatients. LUS only adds little value to clinical features alone. |
| format | Article |
| id | doaj-art-14fed94ce7ad4093aed64e6dba400a89 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-14fed94ce7ad4093aed64e6dba400a892025-01-28T03:45:11ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-060181Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening centerOlivier Hugli0Jean-Yves Meuwly1Noémie Boillat-Blanco2Pierre-Nicolas Carron3Siméon Schaad4Thomas Brahier5Mary-Anne Hartley6Jean-Baptiste Cordonnier7Luca Bosso8Tanguy Espejo9Olivier Pantet102 Emergency Department, Lausanne University Hospital, University of Lausanne, Lausanne, SwitzerlandDepartment of Radiology, Lausanne University Hospital, Lausanne, SwitzerlandInfectious Diseases Service, Lausanne University Hospital, Lausanne, SwitzerlandEmergency Department, Lausanne University Hospital, Lausanne, SwitzerlandInfectious Diseases Service, University Hospital of Lausanne, Lausanne, SwitzerlandInfectious Diseases, CHUV, Lausanne, SwitzerlandDigital Global Health Department, University of Lausanne, Lausanne, SwitzerlandMachine Learning and Optimization Laboratory, EPFL, Lausanne, SwitzerlandEmergency Department, Lausanne University Hospital Emergency Care Service, Lausanne, SwitzerlandEmergency Department, Lausanne University Hospital Emergency Care Service, Lausanne, SwitzerlandAdult Intensive Care Unit, Lausanne University Hospital, Lausanne, SwitzerlandObjectives Early identification of SARS-CoV-2 infection is important to guide quarantine and reduce transmission. This study evaluates the diagnostic performance of lung ultrasound (LUS), an affordable, consumable-free point-of-care tool, for COVID-19 screening.Design, setting and participants This prospective observational cohort included adults presenting with cough and/or dyspnoea at a SARS-CoV-2 screening centre of Lausanne University Hospital between 31 March and 8 May 2020.Interventions Investigators recorded standardised LUS images and videos in 10 lung zones per patient. Two blinded independent experts reviewed LUS recording and classified abnormal findings according to prespecified criteria to investigate their predictive value to diagnose SARS-CoV-2 infection according to PCR on nasopharyngeal swabs (COVID-19 positive vs COVID-19 negative).Primary and secondary outcome measures We finally combined LUS and clinical findings to derive a multivariate logistic regression diagnostic score.Results Of 134 included patients, 23% (n=30/134) were COVID-19 positive and 77% (n=103/134) were COVID-19 negative; 85%, (n=114/134) cases were previously healthy healthcare workers presenting within 2–5 days of symptom onset (IQR). Abnormal LUS findings were significantly more frequent in COVID-19 positive compared with COVID-19 negative (45% vs 26%, p=0.045) and mostly consisted of focal pathologic B lines. Combining clinical findings in a multivariate logistic regression score had an area under the receiver operating curve of 80.3% to detect COVID-19, and slightly improved to 84.5% with the addition of LUS features.Conclusions COVID-19-positive patients are significantly more likely to have lung pathology by LUS. However, LUS has an insufficient sensitivity and is not an appropriate screening tool in outpatients. LUS only adds little value to clinical features alone.https://bmjopen.bmj.com/content/12/6/e060181.full |
| spellingShingle | Olivier Hugli Jean-Yves Meuwly Noémie Boillat-Blanco Pierre-Nicolas Carron Siméon Schaad Thomas Brahier Mary-Anne Hartley Jean-Baptiste Cordonnier Luca Bosso Tanguy Espejo Olivier Pantet Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center BMJ Open |
| title | Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center |
| title_full | Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center |
| title_fullStr | Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center |
| title_full_unstemmed | Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center |
| title_short | Point-of-care lung ultrasonography for early identification of mild COVID-19: a prospective cohort of outpatients in a Swiss screening center |
| title_sort | point of care lung ultrasonography for early identification of mild covid 19 a prospective cohort of outpatients in a swiss screening center |
| url | https://bmjopen.bmj.com/content/12/6/e060181.full |
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