Diagnostic Value of Lung Ultrasonography in COVID-19 Patients Presenting to the Emergency Department

Year 2024, , 57 - 65, 16.08.2024

İbrahim Sarbay Halil Doğan

https://doi.org/10.55694/jamer.1474004

Abstract

Aim: It was aimed to investigate whether ultrasonographic evaluation of the lungs has a diagnostic value for COVID-19 pneumonia in patients who presented to the emergency department (ED) with symptoms suggestive of COVID-19.
Materials and Methods: A prospective, cross-sectional, observational study was conducted in the Emergency Medicine Department of XXX Hospital over 2 months. A total number of 204 adult patients who presented with symptoms suggestive of COVID-19 were included in the study. The findings and results obtained from the Lung Ultrasonography (LUS) and Thorax Computed Tomography (CT) were collected.
Results: 112 patients had Thorax CT findings consistent with COVID-19 pneumonia. 104 (92.86%) of them were “LUS positive”. The sensitivity of LUS in the diagnosis of COVID-19 was 93.33% and specificity was 80%, Positive Predictive Value was 82.96%, and Negative Predictive Value was 92%. Patchy B-lines was the most sensitive LUS finding. ROC analysis was performed for two different COVID-19 LUS scores: In the patient group, an “LUS score” above 13 had a 80% sensitivity and 52.63% specificity in terms of 14-day mortality. Also a “Total LUS Score” above 13 had a sensitivity of 79.46% and specificity of 57.89% for 14-day mortality.
Conclusion: LUS can assist the emergency physician in triage and clinical decision-making in COVID-19. We have defined a novel COVID-19 “Total LUS Score”. This score had a better specificity, and similar sensitivity compared to “LUS Score” which was defined in the literature before, and both were found to be associated with poor clinical outcomes. Patchy B-lines (89.3%) and Pleural Thickening (63.4%) are the most common COVID-19 related findings in LUS. It is recommended to look for these two findings in patients with suspected COVID-19.

Keywords

COVID-19, Ultrasonography, Pneumonia

Acil Servise Başvuran COVID-19 Hastalarında Akciğer Ultrasonografisinin Tanısal Değeri

Abstract

Amaç: Acil servise (AS) COVID-19 düşündüren semptomlarla başvuran hastalarda akciğerlerin ultrasonografik değerlendirilmesinin, COVİD-19 pnömonisi açısından tanısal değerinin olup olmadığının araştırılması amaçlandı.
Gereç ve Yöntemler: Prospektif, kesitsel, gözlemsel bir çalışma olarak XXX Hastanesi Acil Tıp Kliniği'nde 2 aylık periyotta gerçekleştirildi. Çalışmaya COVID-19'u düşündüren semptomlarla başvuran toplam 204 yetişkin hasta dahil edildi. Akciğer Ultrasonografisi (LUS) ve Toraks Bilgisayarlı Tomografisinden (BT) elde edilen bulgular ve sonuçlar toplandı.
Bulgular: 112 hastanın Toraks BT bulguları COVID-19 pnömonisi ile uyumluydu. Bunların 104’ü (%92,86) “LUS pozitif” idi. LUS'un COVID-19 tanısında duyarlılığı %93,33, özgüllüğü %80, Pozitif Prediktif Değeri %82,96, Negatif Prediktif Değeri ise %92 olarak belirlendi. Düzensiz B çizgileri en hassas LUS bulgusuydu. İki farklı COVID-19 LUS skoru için ROC analizi yapıldı: Hasta grubunda “LUS skoru”nun 13'ün üzerinde olmasının 14 günlük mortalite açısından duyarlılığı %80, özgüllüğü ise %52,63 idi. “Toplam LUS Skoru”nun 13'ün üzerinde olmasının ise 14 günlük mortalite için duyarlılığı %79,46, özgüllüğü ise %57,89 idi.
Sonuç: LUS, acil tıp hekimine COVID-19'da triyaj ve klinik karar vermede yardımcı olabilir. Çalışmada tanımlanan yeni COVID-19 “Toplam LUS Skoru”nun daha önce literatürde tanımlanan “LUS Skoru”na göre daha iyi özgüllüğe ve benzer duyarlılığa sahip olduğu ve her ikisinin de kötü klinik sonuçlarla ilişkili olduğu görüldü. Düzensiz B çizgileri (%89,3) ve Plevral Kalınlaşma (%63,4) LUS'ta en sık görülen COVİ-ID-19 ile ilgili bulgulardır. COVID-19 şüphesi olan hastalarda bu iki bulgunun aranması önerilir.

Keywords

COVID-19, Ultrasonografi, Pnömoni

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