Assessing COVID‐19 pneumonia—Clinical extension and risk with point‐of‐care ultrasound: A multicenter, prospective, observational study

Abstract

Background Assessing the extent of lung involvement is important for the triage and care of COVID‐19 pneumonia. We sought to determine the utility of point‐of‐care ultrasound (POCUS) for characterizing lung involvement and, thereby, clinical risk determination in COVID‐19 pneumonia. Methods This multicenter, prospective, observational study included patients with COVID‐19 who received 12‐zone lung ultrasound and chest computed tomography (CT) scanning in the emergency department (ED). We defined lung disease severity using the lung ultrasound score (LUS) and chest CT severity score (CTSS). We assessed the association between the LUS and poor outcome (ICU admission or 30‐day all‐cause mortality). We also assessed the association between the LUS and hospital length of stay. We examined the ability of the LUS to differentiate between disease severity groups. Lastly, we estimated the correlation between the LUS and CTSS and the interrater agreement for the LUS. We handled missing data by multiple imputation with chained equations and predictive mean matching. Results We included 114 patients treated between March 19, 2020, and May 4, 2020. An LUS ≥12 was associated with a poor outcome within 30 days (hazard ratio [HR], 5.59; 95% confidence interval [CI], 1.26–24.80; P = 0.02). Admission duration was shorter in patients with an LUS <12 (adjusted HR, 2.24; 95% CI, 1.47–3.40; P < 0.001). Mean LUS differed between disease severity groups: no admission, 6.3 (standard deviation [SD], 4.4); hospital/ward, 13.1 (SD, 6.4); and ICU, 18.0 (SD, 5.0). The LUS was able to discriminate between ED discharge and hospital admission excellently, with an area under the curve of 0.83 (95% CI, 0.75–0.91). Interrater agreement for the LUS was strong: κ = 0.88 (95% CI, 0.77–0.95). Correlation between the LUS and CTSS was strong: κ = 0.60 (95% CI, 0.48–0.71). Conclusions We showed that baseline lung ultrasound ‐ is associated with poor outcomes, admission duration, and disease severity. The LUS also correlates well with CTSS. Point‐of‐care lung ultrasound may aid the risk stratification and triage of patients with COVID‐19 at the ED.

Keywords

• COVID‐19
• 30‐day mortality
• ICU admission
• lung ultrasound
• pneumonia
• point‐of‐care ultrasound