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. 2022 May 27;11(11):3032.
doi: 10.3390/jcm11113032.

Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

Paolo Bima  1   2 , Emanuele Pivetta  1 , Denise Baricocchi  2   3 , Jacopo Davide Giamello  2   4 , Francesca Risi  1   2 , Matteo Vesan  1   2 , Michela Chiarlo  5 , Giuliano De Stefano  6 , Enrico Ferreri  7 , Giuseppe Lauria  4 , Stefano Podio  2 , Peiman Nazerian  6 , Franco Aprà  5 , Enrico Lupia  1   8 , Fulvio Morello  1   8 , On Behalf Of The Coded Study Investigators
Affiliations

Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department

Paolo Bima et al. J Clin Med. .

Abstract

In the Emergency Department (ED), the decision to hospitalize or discharge COVID-19 patients is challenging. We assessed the utility of lung ultrasound (LUS), alone or in association with a clinical rule/score. This was a multicenter observational prospective study involving six EDs (NCT046291831). From October 2020 to January 2021, COVID-19 outpatients discharged from the ED based on clinical judgment were subjected to LUS and followed-up at 30 days. The primary clinical outcome was a composite of hospitalization or death. Within 393 COVID-19 patients, 35 (8.9%) reached the primary outcome. For outcome prognostication, LUS had a C-index of 0.76 (95%CI 0.68−0.84) and showed good performance and calibration. LUS-based classification provided significant differences in Kaplan−Meier curves, with a positive LUS leading to a hazard ratio of 4.33 (95%CI 1.95−9.61) for the primary outcome. The sensitivity and specificity of LUS for primary outcome occurrence were 74.3% (95%CI 59.8−88.8) and 74% (95%CI 69.5−78.6), respectively. The integration of LUS with a clinical score further increased sensitivity. In patients with a negative LUS, the primary outcome occurred in nine (3.3%) patients (p < 0.001 vs. unselected). The efficiency for rule-out was 69.7%. In unvaccinated ED patients with COVID-19, LUS improves prognostic stratification over clinical judgment alone and may support standardized disposition decisions.

Keywords: COVID-19; disposition; lung ultrasound; mortality; prognosis; score.

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Conflict of interest statement

All authors state the absence of any potential financial and personal relationships with other people or organizations, even unrelated to the present study.

Figures

Figure 1
Figure 1
Panel (A): Lung areas for the calculation of the modified LUS score. 1: right upper antero-lateral area; 2: right lower antero-lateral area; 3: left upper antero-lateral area; 4: left lower antero-lateral area; 5: right upper posterior area; 6: right lower posterior area; 7: left upper posterior area; 8: left lower posterior area. Panel (B): representative LUS image showing B-lines. Panel (C): representative LUS image showing a lung consolidation.
Figure 2
Figure 2
Patient number and primary and secondary outcome occurrence in patients stratified by LUS results.
Figure 3
Figure 3
ROC curve analysis for prediction of (A) primary outcome and (B) secondary outcome. TP: True Positive; TN: True Negative; FP: False Positive; FN: False Negative.
Figure 4
Figure 4
Kaplan–Meier curves for the (A) primary outcome and (B) secondary outcome in patients stratified by LUS results.
See this image and copyright information in PMC

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