Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 22;14(1):11.
doi: 10.1186/s13089-022-00257-7.

The correlation between point-of-care ultrasound and digital tomosynthesis when used with suspected COVID-19 pneumonia patients in primary care

Pablo Fabuel Ortega  1 , Noelia Almendros Lafuente  1 , Sandra Cánovas García  2 , Laura Martínez Gálvez  1 , Aurora González-Vidal  3
Affiliations

The correlation between point-of-care ultrasound and digital tomosynthesis when used with suspected COVID-19 pneumonia patients in primary care

Pablo Fabuel Ortega et al. Ultrasound J. .

Abstract

Background: The use of lung ultrasound (LU) with COVID-19 pneumonia patients should be validated in the field of primary care (PC). Our study aims to evaluate the correlation between LU and radiographic imaging in PC patients with suspected COVID-19 pneumonia.

Methods: This observational, prospective and multicentre study was carried out with patients from a PC health area whose tests for COVID-19 and suspected pneumonia had been positive and who then underwent LU and a digital tomosynthesis (DT). Four PC physicians obtained data regarding the patients' symptoms, examination, medical history and ultrasound data for 12 lung fields: the total amount of B lines (zero to four per field), the irregularity of the pleural line, subpleural consolidation, lung consolidation and pleural effusion. These data were subsequently correlated with the presence of pneumonia by means of DT, the need for hospital admission and a consultation in the hospital emergency department in the following 15 days.

Results: The study was carried out between November 2020 and January 2021 with 70 patients (40 of whom had pneumonia, confirmed by means of DT). Those with pneumonia were older, had a higher proportion of arterial hypertension and lower oxygen saturation (sO2). The number of B lines was higher in patients with pneumonia (16.53 vs. 4.3, p < 0.001). The area under the curve for LU was 0.87 (95% CI 0.78-0.96, p < 0.001), and when establishing a cut-off point of six B lines or more, the sensitivity was 0.875 (95% CI 0.77-0.98, p < 0.05), the specificity was 0.833 (95% CI 0.692-0.975, p < 0.05), the positive-likelihood ratio was 5.25 (95% CI 2.34-11.79, p < 0.05) and the negative-likelihood ratio was 0.15 (95% CI 0.07-0.34, p < 0.05). An age of ≥ 55 and a higher number of B lines were associated with admission. Patients who required admission (n = 7) met at least one of the following criteria: ≥ 55 years of age, sO2 ≤ 95%, presence of at least one subpleural consolidation or ≥ 21 B lines.

Conclusions: LU has great sensitivity and specificity for the diagnosis of COVID-19 pneumonia in PC. Clinical ultrasound findings, along with age and saturation, could, therefore, improve decision-making in this field.

Keywords: Coronavirus infection; Family practice; Pneumonia; Radiography; Thoracic; Ultrasonography.

PubMed Disclaimer

Conflict of interest statement

All the authors declare no conflict of interests.

Figures

Fig. 1
Fig. 1
Patient flow diagram describing patient recruitment process. *Patients were recruited consecutively once Investigator 2 finished the evaluation with the previous patient. AP-RX specific high-resolution circuit between PC and the radiology department, DT digital tomosynthesis, LU lung ultrasound, ED emergency department
Fig. 2
Fig. 2
Table for ultrasound data collection. Irreg. pleu irregular pleural line, Subpleural C subpleural consolidation
Fig. 3
Fig. 3
Epidemiological context
Fig. 4
Fig. 4
Patient flow diagram describing inclusion and exclusion criteria. IC informed consent, LU lung ultrasound, DT digital tomosynthesis
Fig. 5
Fig. 5
Distribution by sex and age
Fig. 6
Fig. 6
ROC curve of the sum of the B lines of all the lung fields and pneumonia in digital tomosynthesis. ROC receiver operating characteristic curve
Fig. 7
Fig. 7
Management proposal for patients with suspected COVID-19 pneumonia in PC
See this image and copyright information in PMC

References

    1. Tung-Chen Y, Algora-Martín A, Llamas-Fuentes R, Rodríguez-Fuertes P, Martínez Virto AM, Sanz-Rodríguez E, et al. Point-of-care ultrasonography in the initial characterization of patients with COVID-19. Med Clín. 2021;156(10):477–484. - PMC - PubMed
    1. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020;296(2):E32–E40. doi: 10.1148/radiol.2020200642. - DOI - PMC - PubMed
    1. Revel M-P, Parkar AP, Prosch H, Silva M, Sverzellati N, Gleeson F, et al. COVID-19 patients and the radiology department—advice from the European Society of Radiology (ESR) and the European Society of Thoracic Imaging (ESTI) Eur Radiol. 2020;20:1–7. - PMC - PubMed
    1. Calvo I, SantaCruz-Calvo S, Aranzana MG, Mármol P, Luque JÁ, Peral I, et al. Digital tomosynthesis and COVID-19: an improvement in the assessment of pulmonary opacities. Arch Bronconeumol. 2020;56(11):761–763. doi: 10.1016/j.arbres.2020.06.017. - DOI - PMC - PubMed
    1. Choo JY, Lee KY, Yu A, Kim J-H, Lee SH, Choi JW, et al. A comparison of digital tomosynthesis and chest radiography in evaluating airway lesions using computed tomography as a reference. Eur Radiol. 2016;26(9):3147–3154. doi: 10.1007/s00330-015-4127-z. - DOI - PubMed

LinkOut - more resources