THE ROLE OF POINT-OF-CARE ULTRASONOGRAPHY IN THE INITIAL CHARACTERIZATION OF COVID-19 PATIENTS: RESULTS FROM A PROSPECTIVE MULTICENTRIC STUDY.

  1. yale tung chen
  2. Rafael Llamas Fuentes
  3. Pablo Rodriguez Fuertes

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Abstract

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) is a highly contagious illness caused by the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is growing evidence regarding the imaging findings of COVID-19, in Chest X-ray and CT scan, however their availability in this pandemic outbreak might be compromised. At this moment, the role of Point-of-care ultrasonography (POCUS) has yet to be explored. OBJECTIVES: The main purpose of this study is to describe the POCUS findings of the disease in COVID-19 patients admitted to the emergency department (ED). Determining the correlation of these parameters with vital signs, laboratory results and chest X-ray, as well as, therapeutic decisions and prognosis. METHODS: Prospective study carried out in the emergency department (ED) of two academic hospitals. High suspicion or confirmed COVID-19 patients were subjected to the ultrasonographic measurement of the inferior vena cava (IVC), focused cardiac ultrasound (FOCUS), and Lung Ultrasonography (Lung POCUS). RESULTS: Between March and April 2020, ninety-six patients were enrolled. The mean age was 68.2 years (SD 17.5). The most common finding in Lung POCUS was an irregular pleural line (63.2%) followed by bilateral confluent (55.2%) and isolated B-lines (53.1%), which was associated with a positive RT-PCR (OR 4.729, 95% CI: 1.989-11.246; p<0.001), and correlated with IL-6 levels (rho = 0.622; p = 0.002). The IVC moderately correlated with levels of pO2, expiratory (rho = -0.539; p =0.014) and inspiratory (rho = -0.527; p =0.017), with troponin I (rho = 0.509; p=0.03). After POCUS exam, almost 20% of the patients had an associated condition that required a change in the treatment or management. CONCLUSION: In this pandemic era, as the shortage of resources constitutes an undeniable public health threat, POCUS presents the potential to impact in diagnosis, management and prognosis of our confirmed or suspected COVID-19 patients.

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    SciScore for 10.1101/2020.05.15.20103333: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was conducted in accordance with the Declaration of Helsinki, and was approved by the Research Ethics Committee of each University Hospital involved.
    Consent: Informed consent was obtained from each enrolled patient.
    Randomizationnot detected.
    BlindingThe physicians were blinded to the patient past medical history, vital signs, symptoms or laboratory measurements.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were conducted with IBM SPSS software v20.0
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    Due to its limitations, diagnostic imaging plays a key role in the management of these patients. A study of 1049 patients undergoing chest CT scan and RT-PCR testing determined that CT abnormalities had a highly sensitivity for diagnosis of COVID-19 patients (4), suggesting that CT scan should be considered as a screening tool, especially in epidemic areas with high pre-test probability. However, the use of CT scan in the ED has many limitations, such as the radiation exposure, especially for mild illness, the low availability and the contraindication of its use in unstable patients. Therefore in many centers CT scans have been replaced for chest X-ray. However, as we have seen, chest X-ray has shown to have a very low NPV (34.9%). In a study of patients undergoing an initial screening for COVID-19, they found a sensitivity of 25% and a specificity of 90% (13). In our study we found that 27 patients with normal chest X-ray, 23 (85.1%) had a pathological POCUS finding. A previous study found that a normal chest X-ray was present in 31% of COVID-19 RT-PCR positive patients (14), which is similar to our results (28.4%). We hypothesize that this is due to the low accuracy of X-ray for detecting interstitial abnormalities (5), represented in our study as isolated B-lines on Lung POCUS, and becoming apparent on X-ray as the disease progresses, with the appearance of confluent B-lines and other findings. - Therapy: By adding POCUS to our protocol, we could safely exclude the probabi...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    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.

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  2. Version published to 10.1101/2020.05.15.20103333v1 on medRxiv