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Multicenter Study
. 2024 Nov 15;230(5):e1092-e1100.
doi: 10.1093/infdis/jiae382.

Validation of Lung Ultrasound for Coronavirus Disease 2019 Prognostication in an International Multicenter Cohort Study

Paul W Blair  1   2 , Trishul Siddharthan  3 , Phabiola M Herrera  3 , Erjia Cui  4 , Peter Waitt  5 , Shakir Hossen  3 , Tiffany C Fong  6 , Lalaine Anova  7 , Hector Erazo  8 , Cristin Mount  9 , Kristen Pettrone  7 , Richard E Rothman  6 , Simon D Pollett  10   11 , Ciprian Crainiceanu  12 , Danielle V Clark  7 ; Rapid Assessment of Infection with SONography (RAISON) Research Group and the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) Research Group
Collaborators, Affiliations
Multicenter Study

Validation of Lung Ultrasound for Coronavirus Disease 2019 Prognostication in an International Multicenter Cohort Study

Paul W Blair et al. J Infect Dis. .

Abstract

Background: Despite many studies evaluating lung ultrasound (LUS) for coronavirus disease 2019 (COVID-19) prognostication, the generalizability and utility across clinical settings are uncertain.

Methods: Adults (≥18 years of age) with COVID-19 were enrolled at 2 military hospitals, an emergency department, home visits, and a homeless shelter in the United States, and in a referral hospital in Uganda. Participants had a 12-zone LUS scan performed at time of enrollment and clips were read off-site. The primary outcome was progression to higher level of care after the ultrasound scan. We calculated the cross-validated area under the curve for the validation cohort for individual LUS features.

Results: We enrolled 191 participants with COVID-19 (57.9% female; median age, 45.0 years [interquartile range, 31.5-58.0 years]). Nine participants clinically deteriorated. The top predictors of worsening disease in the validation cohort measured by cross-validated area under the curve were B-lines (0.88 [95% confidence interval {CI}, .87-.90]), discrete B-lines (0.87 [95% CI, .85-.88]), oxygen saturation (0.82 [95%, CI, .81-.84]), and A-lines (0.80 [95% CI, .78-.81]).

Conclusions: In an international multisite point-of-care ultrasound cohort, LUS parameters had high discriminative accuracy. Ultrasound can be applied toward triage across a wide breadth of care settings during a pandemic.

Keywords: COVID-19; SARS-CoV-2; diagnostic imaging; triage; ultrasonography.

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Conflict of interest statement

Potential conflicts of interest. S. D. P. reports that the USUHS IDCRP, a US DOD institution, and HJF were funded under a cooperative research and development agreement to conduct an unrelated phase 3 COVID-19 monoclonal antibody immunoprophylaxis trial sponsored by AstraZeneca. The HJF, in support of the USUHS IDCRP, was funded by the DOD Joint Program Executive Office for Chemical, Biological, Radiological, and Nuclear Defense to augment the conduct of an unrelated phase 3 vaccine trial sponsored by AstraZeneca. Both of these trials were part of the US government COVID-19 response. Neither is related to the work presented here. T.S. receives consulting feeds from Verona Pharmaceuticals, Apogee Therapeutics, and honoraraia from American Thoracic Society and the COPD foundation. T.S. is an advisor to 4D Medical. C.C. receives consulting fees from Johnson & Johnson and Bayer AG regarding unrelated wearable devices. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
A–F, Sensitivity and specificity at different lung field involvement (%) or physiologic parameter cutoffs in original and validation cohorts.
See this image and copyright information in PMC

References

    1. Gartlehner G, Wagner G, Affengruber L, et al. . Point-of-care ultrasonography in patients with acute dyspnea: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med 2021; 174:967–76. - PubMed
    1. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015; 147:1659–70. - PubMed
    1. Volpicelli G, Elbarbary M, Blaivas M, et al. . International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38:577–91. - PubMed
    1. Blair PW, Siddharthan T, Liu G, et al. . Point-of-care lung ultrasound predicts severe disease and death due to COVID-19: a prospective cohort study. Crit Care Explor 2022; 4:e0732. - PMC - PubMed
    1. Rubio-Gracia J, Giménez-López I, Garcés-Horna V, et al. . Point-of-care lung ultrasound assessment for risk stratification and therapy guiding in COVID-19 patients: a prospective noninterventional study. Eur Respir J 2021:58:2004283. - PMC - PubMed