Point‐of‐Care Ultrasound Predicts Clinical Outcomes in Patients With COVID ‐19

  1. Andre Kumar
  2. Isabel Weng
  3. Sally Graglia
  4. Thomas Lew
  5. Kavita Gandhi
  6. Farhan Lalani
  7. David Chia
  8. Youyou Duanmu
  9. Trevor Jensen
  10. Viveta Lobo
  11. Jeffrey Nahn
  12. Nicholas Iverson
  13. Molly Rosenthal
  14. Alexandra June Gordon
  15. John Kugler

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Abstract

Point‐of‐care ultrasound (POCUS) detects the pulmonary manifestations of COVID‐19 and may predict patient outcomes.

Methods

We conducted a prospective cohort study at four hospitals from March 2020 to January 2021 to evaluate lung POCUS and clinical outcomes of COVID‐19. Inclusion criteria included adult patients hospitalized for COVID‐19 who received lung POCUS with a 12‐zone protocol.

Each image was interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was the need for intensive care unit (ICU) admission versus no ICU admission. Secondary outcomes included intubation and supplemental oxygen usage.

Results

N = 160 patients were included. Among critically ill patients, B‐lines (94 vs 76%; P  < .01) and consolidations (70 vs 46%; P  < .01) were more common. For scans collected within 24 hours of admission (N = 101 patients), early B‐lines (odds ratio [OR] 4.41 [95% confidence interval, CI: 1.71–14.30]; P  < .01) or consolidations (OR 2.49 [95% CI: 1.35–4.86]; P  < .01) were predictive of ICU admission. Early consolidations were associated with oxygen usage after discharge (OR 2.16 [95% CI: 1.01–4.70]; P  = .047). Patients with a normal scan within 24 hours of admission were less likely to require ICU admission (OR 0.28 [95% CI: 0.09–0.75]; P  < .01) or supplemental oxygen (OR 0.26 [95% CI: 0.11–0.61]; P  < .01). Ultrasound findings did not dynamically change over a 28‐day scanning window after symptom onset.

Conclusions

Lung POCUS findings detected within 24 hours of admission may provide expedient risk stratification for important COVID‐19 clinical outcomes, including future ICU admission or need for supplemental oxygen. Conversely, a normal scan within 24 hours of admission appears protective. POCUS findings appeared stable over a 28‐day scanning window, suggesting that these findings, regardless of their timing, may have clinical implications.

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  1. Version published to 10.1002/jum.15818
  2. ScreenIT

    SciScore for 10.1101/2021.04.13.21255445: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study was approved by the Institutional Review Boards of Stanford University and the University of California, San Francisco.
    Consent: A waiver of consent was obtained by both institutions.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    BlindingThe researchers were blinded to patient outcomes when interpreting the images.
    Power AnalysisAnalysis: Our calculated sample size for this study was 94 patients based on reasonable assumptions (15% event rate, 80% power, alpha 0.05).

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations to this study. Certain patient conditions, such as intubation or patient mobility, prevented the provider from acquiring all 12 zones, particularly the posterior zones. Therefore, not all patients received a 12-zone scan, which limits the generalizability of the findings’ frequencies by location. Patients were scanned based on provider discretion, but it is possible that patients with certain features on X-ray or CT were more likely to receive a LUS. We did not control for patient health conditions that may have confounded the sonographic findings (e.g. interstitial lung disease), although these diseases had low prevalence in our population (Table 1). Finally, our population included only patients hospitalized for COVID-19. Therefore, our findings may not be generalizable to outpatient or triage settings, although other studies have examined the utility of POCUS in these venues.2,7,19 In conclusion, POCUS may provide expedient risk stratification for patients hospitalized with COVID-19, and it may have similar utility as other scoring systems that utilize radiographical or laboratory markers. Several POCUS findings, including B-lines and consolidations, were predictive of ICU admission, intubation, subsequent supplemental oxygen usage, or the need for oxygen on discharge. The predictive utility of these findings was also present when we limited our analysis to scans collected within 24 hours of admission. Importantly, a normal lung ultrasound was...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04384055Enrolling by invitationPredicting Outcomes for Covid-19 Using Sonography

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.13.21255445v1 on medRxiv