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

Öz

Aim: The aim of this study was to investigate the diagnostic value of ultrasonographic evaluation of the lungs for COVID-19 pneumonia in patients admitted to the emergency department (ED) with suggestive symptoms. Materials and Methods: A prospective, cross-sectional, observational study was conducted in the ED of Bakirkoy Dr. Sadi Konuk Training and Research Hospital over a 2-month period. A total of 204 adult patients presenting with symptoms suggestive of COVID-19 were included. Data from Lung Ultrasonography (LUS) and Thorax Computed Tomography (CT) were collected for analysis. Results: 112 patients had thoracic CT findings consistent with COVID-19 pneumonia. 104 (92.86%) were “LUS positive”. The sensitivity of LUS was 93.33%, and specificity was 80%. The positive predictive value was 82.96%, and the negative predictive value was 92%. Patchy B-lines were the most sensitive LUS finding. ROC analysis was performed for two COVID-19 LUS scores: In the patient group, an “LUS score” above 13 had an 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 emergency physicians in triage and clinical decision-making for COVID-19. The total LUS Score offers better specificity and similar sensitivity compared to both, which were 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 specifically look for these two findings in patients suspected of having COVID-19.

Anahtar Kelimeler

• COVID-19
• pneumonia
• ultrasonography

Acil Servise Başvuran COVID-19 Hastalarında Akciğer Ultrasonografisinin Tanısal Değeri

Öz

Amaç: Acil servise (AS) COVID-19 düşündüren semptomlarla başvuran hastalarda akciğerlerin ultrasonografik değerlendiril- mesinin, COVID-19 pnömonisi açısından tanısal değerinin olup olmadığının araştırılması amaçlandı. Gereç ve Yöntemler: Prospektif, kesitsel, gözlemsel bir çalışma olarak Bakırköy Dr Sadi Konuk Eğitim ve Araştırma 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. COVID-19 “Toplam LUS Sko- ru”nun, “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 COVID-19 ile ilgili bulgulardır. COVID-19 şüphesi olan hastalarda bu iki bulgunun aranması önerilir.

Anahtar Kelimeler

• COVID-19
• Pnömoni
• Ultrasonografi

Kaynakça

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