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. 2020 Jun 19;21(4):771-778.
doi: 10.5811/westjem.2020.5.47743.

Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19

Joseph R Pare  1   2 , Ingrid Camelo  3 , Kelly C Mayo  1   2 , Megan M Leo  1   2 , Julianne N Dugas  2 , Kerrie P Nelson  4 , William E Baker  1   2 , Faizah Shareef  1 , Patricia M Mitchell  2 , Elissa M Schechter-Perkins  1   2
Affiliations

Point-of-care Lung Ultrasound Is More Sensitive than Chest Radiograph for Evaluation of COVID-19

Joseph R Pare et al. West J Emerg Med. .

Abstract

Introduction: Current recommendations for diagnostic imaging for moderately to severely ill patients with suspected coronavirus disease 2019 (COVID-19) include chest radiograph (CXR). Our primary objective was to determine whether lung ultrasound (LUS) B-lines, when excluding patients with alternative etiologies for B-lines, are more sensitive for the associated diagnosis of COVID-19 than CXR.

Methods: This was a retrospective cohort study of all patients who presented to a single, academic emergency department in the United States between March 20 and April 6, 2020, and received LUS, CXR, and viral testing for COVID-19 as part of their diagnostic evaluation. The primary objective was to estimate the test characteristics of both LUS B-lines and CXR for the associated diagnosis of COVID-19. Our secondary objective was to evaluate the proportion of patients with COVID-19 that have secondary LUS findings of pleural abnormalities and subpleural consolidations.

Results: We identified 43 patients who underwent both LUS and CXR and were tested for COVID-19. Of these, 27/43 (63%) tested positive. LUS was more sensitive (88.9%, 95% confidence interval (CI), 71.1-97.0) for the associated diagnosis of COVID-19 than CXR (51.9%, 95% CI, 34.0-69.3; p = 0.013). LUS and CXR specificity were 56.3% (95% CI, 33.2-76.9) and 75.0% (95% CI, 50.0-90.3), respectively (p = 0.453). Secondary LUS findings of patients with COVID-19 demonstrated 21/27 (77.8%) had pleural abnormalities and 10/27 (37%) had subpleural consolidations.

Conclusion: Among patients who underwent LUS and CXR, LUS was found to have a higher sensitivity than CXR for the evaluation of COVID-19. This data could have important implications as an aid in the diagnostic evaluation of COVID-19, particularly where viral testing is not available or restricted. If generalizable, future directions would include defining how to incorporate LUS into clinical management and its role in screening lower-risk populations.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. This study used REDCap supported by Boston University, CTSI 1UL1TR001430. There are no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Lung ultrasounds. (A) Normal lung ultrasound. A-lines are horizontal lines that can be seen in the absence of pathology. (B) Abnormal lung ultrasound. The pleura is noted at the top of the lung. This is an example of coalescing B-lines shown as what appear to be headlights coming down from the pleura. (C) Abnormal lung ultrasound. Demonstrated is pleural thickening, >3 millimeters by visual estimate was considered abnormal. (D) Abnormal lung ultrasound. Demonstrated is an irregular pleural line seen in viral infections. (E) Abnormal lung ultrasound. Shown is a subpleural consolidation that appears black between the pleura above the pleural line.
Figure 2
Figure 2
Flow chart of enrollment in lung ultrasound study. CI, confidence interval; CXR, chest radiograph; LUS, lung ultrasound; CHF, congestive heart failure; ESRD, end-stage renal disease; TP, true positive; FP, false positive; TN, true negative; FN, false negative.
See this image and copyright information in PMC

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