Point-of-Care Chest Ultrasonography as a Diagnostic Resource for COVID-19 Outbreak in Nursing Homes

Abstract

Objective: Bedside chest ultrasonography, when integrated with clinical data, is an accurate tool for improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasonographic screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)-related pneumonia and improving the appropriateness of hospital referral of residents.

Design: Pragmatic, descriptive, feasibility study from April 2 to April 9, 2020.

Setting and participants: A total of 83 older residents (age 85 ± 8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in 5 nursing homes in Northern Italy.

Methods: Chest ultrasonography was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring 4 different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations, and pleural line indentation, was detected. The specialist team integrated ultrasonography data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed.

Results: The most frequent reasons for ultrasonographic evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasonographic findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and 6 of them required hospitalization. Twelve patients had ultrasonographic patterns suggesting other respiratory diseases, and 2 patients with normal ultrasonographic findings were diagnosed with COPD exacerbation.

Conclusions and implications: In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.

Keywords: Lung ultrasonography; coronavirus; interstitial pneumonia; long-term care; viral pneumonia.

Fig. 1

Ultrasonographic appearance of suspect COVID-19 pneumonia in older patients residing in nursing homes. (A) Transversal scan in intercostal space, with demonstration of subpleural consolidations and diffuse comet-tail artifacts (B-lines). (B) Trasversal scan, with demonstration of indented pleural line associated with diffuse B-lines. (C) Longitudinal scan showing diffuse B-lines in intercostal spaces.

Fig. 2

Overview of the study findings and classification of chest ultrasonographic examinations according to ultrasonographic appearance and clinical data. COPD, chronic obstructive pulmonary disease.