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Observational Study
. 2020 Sep;46(9):1707-1713.
doi: 10.1007/s00134-020-06186-0. Epub 2020 Jul 29.

Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Laurent Zieleskiewicz  1   2 , Thibaut Markarian  3 , Alexandre Lopez  4 , Chloé Taguet  3 , Neyla Mohammedi  4 , Mohamed Boucekine  5 , Karine Baumstarck  5 , Guillaume Besch  6 , Gautier Mathon  7 , Gary Duclos  4 , Lionel Bouvet  8   9   10 , Pierre Michelet  3 , Bernard Allaouchiche  7   9   10 , Kathia Chaumoître  11 , Mathieu Di Bisceglie  11 , Marc Leone  4 ; AZUREA Network
Affiliations
Observational Study

Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia

Laurent Zieleskiewicz et al. Intensive Care Med. 2020 Sep.

Abstract

Purpose: The relationship between lung ultrasound (LUS) and chest computed tomography (CT) scans in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is not clearly defined. The primary objective of our study was to assess the performance of LUS in determining severity of SARS-CoV-2 pneumonia compared with chest CT scan. Secondary objectives were to test the association between LUS score and location of the patient, use of mechanical ventilation, and the pulse oximetry (SpO2)/fractional inspired oxygen (FiO2) ratio.

Methods: A multicentre observational study was performed between 15 March and 20 April 2020. Patients in the Emergency Department (ED) or Intensive Care Unit (ICU) with acute dyspnoea who were PCR positive for SARS-CoV-2, and who had LUS and chest CT performed within a 24-h period, were included.

Results: One hundred patients were included. LUS score was significantly associated with pneumonia severity assessed by chest CT and clinical features. The AUC of the ROC curve of the relationship of LUS versus chest CT for the assessment of severe SARS-CoV-2 pneumonia was 0.78 (CI 95% 0.68-0.87; p < 0.0001). A high LUS score was associated with the use of mechanical ventilation, and with a SpO2/FiO2 ratio below 357.

Conclusion: In known SARS-CoV-2 pneumonia patients, the LUS score was predictive of pneumonia severity as assessed by a chest CT scan and clinical features. Within the limitations inherent to our study design, LUS can be used to assess SARS-CoV-2 pneumonia severity.

Keywords: Chest computed tomography; Diagnostic accuracy; Lung ultrasound; SARS-CoV-2.

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Conflict of interest statement

LZ and TM received fees for teaching ultrasound to GE healthcare customers.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Diagnostic accuracy of LUS score for the detection of severe SARS-CoV-2 pneumonia assessed by chest CT scan. a ROC curve of LUS score versus chest CT scan. AUC = 0.78 (CI 95% 0.68–0.87; p < 0.0001), (b) Gray zone of LUS score versus chest CT scan. Solid line: Se (Sensitivity). Dotted line: Sp (Specificity)
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