Lung ultrasound performed by primary care physicians as a prognostic and diagnostic tool in COVID-19 patients
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Objective To assess the value of abnormal findings of lung POCUS performed by PCPs in patients with SARS-CoV-2 virus infection confined at home in predicting hospitalisations, intensive care admissions, and mortality. Additionally, this study aims to assess the validity of lung POCUS performed by PCPs for FIGURECOVID pneumonia diagnosis. Methods This prospective observational study, conducted in Mallorca and Salamanca, Spain, between January and December 2021, assessed 624 consecutive adult patients (mean age 52.5 ± 18.3 years; 45.7% female) with confirmed SARS-CoV-2 infection and worsening symptoms via home visits or community health centres. Eight primary care physicians received a standardised 5-hour training in lung POCUS. Examinations followed a 12-zone protocol, and POCUS was considered positive if at least one abnormality - ≥ 3 B-lines, subpleural consolidation, or lobar consolidation - was present. Patients were followed for 30 days to confirm pneumonia diagnosis via chest X-ray, CT scan, or inpatient records and to record hospital referral, hospitalisation, ICU admission, and death. Results Abnormal POCUS findings were observed in 58.8% of patients, of whom 50.3% presented pleural line abnormalities, 27.6% subpleural consolidations, and 3.4% lobar consolidations. Patients with positive POCUS were referred to the hospital more frequently than those with negative findings (72.4% vs. 22.8%; OR = 8.83). They also had higher rates of hospitalisation (54.3% vs. 31.7%; OR = 2.57) and mortality (4.3% vs. 0.8%; OR = 5.52), while ICU admission did not differ significantly. For the diagnosis of COVID-19 pneumonia, overall POCUS sensitivity was 68.3%, specificity 43.6%, positive predictive value 78.7%, and negative predictive value 31.1%. Conclusions Lung POCUS performed by primary care physicians demonstrates acceptable prognostic utility for COVID-19 patients in community settings; however, it has limited diagnostic accuracy compared with chest radiography. These findings support its use in resource-limited environments and highlight the need for standardised scanning protocols and training.