Lung ultrasound for the early diagnosis of COVID-19 pneumonia: an international multicenter study
Authors: Giovanni Volpicelli, Luna Gargani, Stefano Perlini, Stefano Spinelli, Greta Barbieri, Antonella Lanotte, Gonzalo García Casasola, Ramon Nogué-Bou, Alessandro Lamorte, Eustachio Agricola, Tomas Villén, Paramjeet Singh Deol, Peiman Nazerian, Francesco Corradi, Valerio Stefanone, Denise Nicole Fraga, Paolo Navalesi, Robinson Ferre, Enrico Boero, Giampaolo Martinelli, Lorenzo Cristoni, Cristiano Perani, Luigi Vetrugno, Cian McDermott, Francisco Miralles-Aguiar, Gianmarco Secco, Caterina Zattera, Francesco Salinaro, Alice Grignaschi, Andrea Boccatonda, Fabrizio Giostra, Marta Nogué Infante, Michele Covella, Giacomo Ingallina, Julia Burkert, Paolo Frumento, Francesco Forfori, Lorenzo Ghiadoni, Thomas Fraccalini, Alessandro Vendrame, Vittoria Basile, Alessandro Cipriano, Francesca Frassi, Massimo Santini, Marco Falcone, Francesco Menichetti, Bruno Barcella, Marzia Delorenzo, Flavia Resta, Giulia Vezzoni, Marco Bonzano, Domenica Federica Briganti, Giovanni Cappa, Ilaria Zunino, Lorenzo Demitry, Damiano Vignaroli, Lorenzo Scattaglia, Santi Di Pietro, Marco Bazzini, Vincenzo Capozza, María Mateos González, Rosa Vilella Gibal, Ramon Piñol Ibarz, Luis Martin Alfaro, Carlos Martin Alfaro, Maria Galindo Alins, Alice Brown, Hannah Dunlop, Maria Luisa Ralli, Paolo Persona, Frances M. Russel, Peter S. Pang, Serena Rovida, Cristian Deana, Diego Franchini
Journal: Intensive Care Medicine (2021)

To analyze the application of a lung ultrasound (LUS)-based diagnostic approach to patients suspected of COVID-19, combining the LUS likelihood of COVID-19 pneumonia with patient's symptoms and clinical history.This is an international multicenter observational study in 20 US and European hospitals. Patients suspected of COVID-19 were tested with reverse transcription-polymerase chain reaction (RT-PCR) swab test and had an LUS examination. We identified three clinical phenotypes based on pre-existing chronic diseases (mixed phenotype), and on the presence (severe phenotype) or absence (mild phenotype) of signs and/or symptoms of respiratory failure at presentation. We defined the LUS likelihood of COVID-19 pneumonia according to four different patterns: high (HighLUS), intermediate (IntLUS), alternative (AltLUS), and low (LowLUS) probability. The combination of patterns and phenotypes with RT-PCR results was described and analyzed.We studied 1462 patients, classified in mild (n = 400), severe (n = 727), and mixed (n = 335) phenotypes. HighLUS and IntLUS showed an overall sensitivity of 90.2% (95% CI 88.23-91.97%) in identifying patients with positive RT-PCR, with higher values in the mixed (94.7%) and severe phenotype (97.1%), and even higher in those patients with objective respiratory failure (99.3%). The HighLUS showed a specificity of 88.8% (CI 85.55-91.65%) that was higher in the mild phenotype (94.4%; CI 90.0-97.0%). At multivariate analysis, the HighLUS was a strong independent predictor of RT-PCR positivity (odds ratio 4.2, confidence interval 2.6-6.7, p < 0.0001).Combining LUS patterns of probability with clinical phenotypes at presentation can rapidly identify those patients with or without COVID-19 pneumonia at bedside. This approach could support and expedite patients' management during a pandemic surge.