Lung Ultrasound using a Handheld Device to Diagnose COVID-19 in the Emergency Department

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic has critically struck healthcare systems and burdened emergency services. To date, there is no accurate and rapid point-of-care diagnostic test. This study aimed to investigate Lung Ultrasound (LUS) against Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test in suspected COVID-19 patients presenting to the emergency department. In 20 eligible patients (mean age ± standard deviation, 49 ± 15 years), 12 had a positive RT-PCR test and undergone an LUS examination over 12 lung zones using a handheld ultrasound device. Each zone was semiquantitatively scored according to the Lung Ultrasound Scoring System (LUSS) from 0 to 3 based on the severity of findings (pleural line irregularity, B-lines, consolidations) and documented the presence of light beam artifacts. A second blinded reader scored the images to investigate interreader reproducibility. The LUSS score had a modest diagnostic performance at 66.6% [95% Confidence Interval (CI), 34.9–90.0%] sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. The light beam artifact was more prevalent and sensitive to COVID-19 patients with 81.8% (95% CI, 48.2–97.7%) sensitivity and 75.0% (95% CI, 34.9–96.8%) specificity. LUS had an almost perfect interreader reproducibility for LUSS (Kendall’s W = 0.961; 95% CI, 0.894–0.985) and light beam artifact (Cohen’s κ = 0.890; 95% CI, 0.683–1.00). Overall, LUS using handheld devices can offer a safe, reproducible, rapid, and feasible first-line tool for detecting COVID-19 patients in emergency departments. The light beam artifact was more sensitive and specific to COVID-19 patients and can be useful for effectively triaging suspected cases.

Keywords

• COVID-19
• SARS-CoV-2
• point-of-care ultrasound
• diagnostic test
• sensitivity
• specificity