Point-of-care lung ultrasound in the assessment of COVID-19: results of a UK multicentre service evaluation
Authors:   Department of Acute Medicine, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham, B18 7QH, UK Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK., Knight Thomas , Parulekar Prashant ,   East Kent Hospitals NHS Trust: East Kent Hospitals University NHS Foundation Trus, Rudge Gavin ,   Institute of Applied Health Research University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK., Lesser Finnian ,   Acute Medicine Department, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, Surrey, RH1 5RH, UK, Dachsel Martin ,   Consultant in Acute Internal Medicine, East Surrey hospital, Aujayeb Avinash ,   Respiratory and Acute Medicine Consultant, Northumbria Healthcare NHS Foundation Trust, North Shields, UK, Lasserson Daniel ,   Sandwell and West Birmingham NHS Trust, Department of Acute Medicine, Birmingham, United Kingdom, Smallwood Nicholas ,   MBChB, MRCP (Acute Medicine), Consultant Acute Medicine, East Surrey Hospital
Published: January 2023

Background: Coronavirus disease 2019 has had a dramatic impact on the delivery of acute care globally. Accurate risk stratification is fundamental to the efficient organisation of care. Point-of-care lung ultrasound offers practical advantages over conventional imaging with potential to improve the operational performance of acute care pathways during periods of high demand. The Society for Acute Medicine and the Intensive Care Society undertook a collaborative evaluation of point-of-care imaging in the UK to describe the scope of current practice and explore performance during real-world application. Methods: A retrospective service evaluation was undertaken of the use of point-of-care lung ultrasound during the initial wave of coronavirus infection in the UK. We report an evaluation of all imaging studies performed outside the intensive care unit. An ordinal scale was used to measure the severity of loss of lung aeration. The relationship between lung ultrasound, polymerase chain reaction for SARS-CoV-2 and 30-day outcomes were described using logistic regression models. Results: Data were collected from 7 hospitals between February and September 2020. In total, 297 ultrasound examinations from 295 patients were recorded. Nasopharyngeal swab samples were positive in 145 patients (49.2% 95%CI 43.5-54.8). A multivariate model combining three ultrasound variables showed reasonable discrimination in relation to the polymerase chain reaction reference (AUC 0.77 95%CI 0.71-0.82). The composite outcome of death or intensive care admission at 30 days occurred in 83 (28.1%, 95%CI 23.3-33.5). Lung ultrasound was able to discriminate the composite outcome with a reasonable level of accuracy (AUC 0.76 95%CI 0.69-0.83) in univariate analysis. The relationship remained statistically significant in a multivariate model controlled for age, sex and the time interval from admission to scan. Conclusion: Point-of-care lung ultrasound is able to discriminate patients at increased risk of deterioration allowing more informed clinical decision making.