Diagnostic accuracy of point-of-care lung ultrasound in COVID-19
Diagnostic accuracy of point-of-care lung ultrasound in COVID-19
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DOI：
10.1136/emermed-2020-210125
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发表时间：
2021-02-01
影响因子：
3.1
通讯作者：
van der Kolk, Brigitta (Britt) Y. M.
中科院分区：
文献类型：
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作者：
Haak, Svenja L.;Renken, Iris J. E.;van der Kolk, Brigitta (Britt) Y. M.
背景 在急诊室 (ED) 诊断 COVID-19 肺部表现的一种有前途的方法是肺部超声检查 (POCUS)。目前使用的 PCR 以及胸部 X 射线和 CT 扫描都有重要的缺点。本研究的目的是评估 POCUS 对急诊室疑似 COVID-19 肺部表现的患者的诊断准确性。 方法 这项前瞻性诊断准确性研究是在我们的非学术 1 级创伤中心（荷兰兹沃勒伊萨拉）的急诊室进行的。患者于 2020 年 4 月 14 日至 4 月 22 日期间入组。在急诊室就诊的疑似 COVID-19 患者（年龄 >= 16 岁）接受了 POCUS。所有患者均接受当前标准护理，包括 PCR（鼻咽拭子）。将 POCUS 的结果与 PCR 或 CT 扫描结果进行比较，以确定诊断的准确性。使用2x2列联表计算诊断准确性测量。结果 100名患者有资格参加本研究，分析了93名患者的数据。通过 PCR 或 CT 发现 27 名患者 (29%) 的 COVID-19 呈阳性。 POCUS 的敏感性为 89%（95% CI 70% 至 97%），特异性为 59%（95% CI 46% 至 71%），阴性预测值为 93%（95% CI 79% 至 98%），阳性预测值为 47%（95% CI 33% 至 61%）。在既往无心肺疾病的患者亚组中 (n=37)，POCUS 的敏感性为 100%（95% CI 70% 至 100%），特异性为 76%（95% CI 54% 至 90%），阴性预测值为 100%（95% CI 79% 至 100%），阳性预测值为 67%（95% CI 41% 至 100%）。 86%）。结论 肺部 POCUS 可以作为一种有价值的、无辐射的工具，用于在评估时排除 ED 患者中 COVID-19 的肺部表现，特别是对于既往没有心肺疾病的患者。
Background A promising modality for diagnosing pulmonary manifestations of COVID-19 in the emergency department (ED) is point-of-care ultrasound (POCUS) of the lungs. The currently used PCR as well as chest X-ray and CT scanning have important disadvantages. The aim of this study is to evaluate the diagnostic accuracy of POCUS in patients with suspected pulmonary manifestations of COVID-19 in the ED.Methods This prospective diagnostic accuracy study was conducted at the ED of our non-academic level 1 trauma centre (Isala, Zwolle, the Netherlands). Patients were enrolled between 14 April and 22 April 2020. Patients (aged >= 16 years) with suspected COVID-19 presenting to the ED underwent POCUS. All patients received current standard of care, including PCR (nasooropharyngeal swab). Outcome of POCUS was compared with PCR or CT scan outcome to determine diagnostic accuracy. Diagnostic accuracy measures were calculated using 2x2 contingency tables.Results 100 patients were eligible to participate in this study, data of 93 patients were analysed. 27 (29%) patients were found positive for COVID-19 by PCR or CT. POCUS had a sensitivity of 89% (95% CI 70% to 97%), specificity of 59% (95% CI 46% to 71%), negative predictive value of 93% (95% CI 79% to 98%) and positive predictive value of 47% (95% CI 33% to 61%). In a subgroup of patients without previous cardiopulmonary disease (n=37), POCUS had a sensitivity of 100% (95% CI 70% to 100%), specificity of 76% (95% CI 54% to 90%), negative predictive value of 100% (95% CI 79% to 100%) and positive predictive value of 67% (95% CI 41% to 86%).Conclusion POCUS of the lungs could serve as a valuable, radiation-free tool for excluding pulmonary manifestations of COVID-19 in patients in the ED at the point of assessment, especially in patients without previous cardiopulmonary disease.