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. 2021 Jan 11;11(1):6.
doi: 10.1186/s13613-020-00799-w.

Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department

Julio Cesar Garcia de Alencar  1 , Julio Flavio Meirelles Marchini  2 , Lucas Oliveira Marino  2 , Sabrina Correa da Costa Ribeiro  2 , Cauê Gasparotto Bueno  2 , Victor Paro da Cunha  2 , Felippe Lazar Neto  2 , Rodrigo Antonio Brandão Neto  2 , Heraldo Possolo Souza  2 ; COVID U. S. P. Registry Team
Collaborators, Affiliations

Lung ultrasound score predicts outcomes in COVID-19 patients admitted to the emergency department

Julio Cesar Garcia de Alencar et al. Ann Intensive Care. .

Abstract

Background: During the COVID-19 pandemic, creating tools to assess disease severity is one of the most important aspects of reducing the burden on emergency departments. Lung ultrasound has a high accuracy for the diagnosis of pulmonary diseases; however, there are few prospective studies demonstrating that lung ultrasound can predict outcomes in COVID-19 patients. We hypothesized that lung ultrasound score (LUS) at hospital admission could predict outcomes of COVID-19 patients. This is a prospective cohort study conducted from 14 March through 6 May 2020 in the emergency department (ED) of an urban, academic, level I trauma center. Patients aged 18 years and older and admitted to the ED with confirmed COVID-19 were considered eligible. Emergency physicians performed lung ultrasounds and calculated LUS, which was tested for correlation with outcomes. This protocol was approved by the local Ethics Committee number 3.990.817 (CAAE: 30417520.0.0000.0068).

Results: The primary endpoint was death from any cause. The secondary endpoints were ICU admission and endotracheal intubation for respiratory failure. Among 180 patients with confirmed COVID-19 who were enrolled (mean age, 60 years; 105 male), the average LUS was 18.7 ± 6.8. LUS correlated with findings from chest CT and could predict the estimated extent of parenchymal involvement (mean LUS with < 50% involvement on chest CT, 15 ± 6.7 vs. 21 ± 6.0 with > 50% involvement, p < 0.001), death (AUC 0.72, OR 1.13, 95% CI 1.07 to 1.21; p < 0.001), endotracheal intubation (AUC 0.76, OR 1.17, 95% CI 1.09 to 1.26; p < 0.001), and ICU admission (AUC: 0.71, OR 1.14, 95% CI 1.07 to 1.21; p < 0.001).

Conclusions: In COVID-19 patients admitted in ED, LUS was a good predictor of death, ICU admission, and endotracheal intubation.

Keywords: COVID-19; Critical care; Emergency medicine; Severe acute respiratory syndrome coronavirus 2; Ultrasonography.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of patient flow through the study
Fig. 2
Fig. 2
ROC Curves and Outcomes. a For LUS versus all-cause mortality. b For LUS versus endotracheal intubation. c For LUS versus ICU admission
See this image and copyright information in PMC

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