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Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study

Arthur W.E. Lieveld, Bram Kok, Frederik H. Schuit, Kaoutar Azijli, Jarom Heijmans, Arjan van Laarhoven, Natascha L. Assman, Ruud S. Kootte, Tycho J. Olgers, Prabath W.B. Nanayakkara, Frank H. Bosch
ERJ Open Research 2020 6: 00539-2020; DOI: 10.1183/23120541.00539-2020
Arthur W.E. Lieveld
1Section General and Acute Internal Medicine, Dept of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
6These authors contributed equally
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  • ORCID record for Arthur W.E. Lieveld
Bram Kok
2Section Acute Medicine, Dept of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
6These authors contributed equally
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Frederik H. Schuit
1Section General and Acute Internal Medicine, Dept of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
6These authors contributed equally
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Kaoutar Azijli
3Section Emergency Medicine, Emergency Dept, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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Jarom Heijmans
4Section Acute Medicine, Dept of Internal Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Arjan van Laarhoven
2Section Acute Medicine, Dept of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
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Natascha L. Assman
2Section Acute Medicine, Dept of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
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Ruud S. Kootte
4Section Acute Medicine, Dept of Internal Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Tycho J. Olgers
5Section Acute Medicine, Dept of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Prabath W.B. Nanayakkara
1Section General and Acute Internal Medicine, Dept of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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  • For correspondence: p.nanayakkara@amsterdamumc.nl
Frank H. Bosch
2Section Acute Medicine, Dept of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
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  • FIGURE 1
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    FIGURE 1

    Study population flowchart. ED: emergency department; CT: computed tomography.

Tables

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  • TABLE 1

    Patient characteristics

    All patientsPCR positivePCR negativep-value
    Subjects n187#86100
    Age years63.7±15.763.4±14.864.1±16.50.668
    Male108 (57.8)50 (58.1)58 (58.0)0.97
    Admission140 (74.9)65 (75.6)75 (75.0)0.855
    Admission ED to IC9 (4.8)8 (9.3)1 (1.0)<0.001
    In hospital mortality9 (4.8)5 (5.8)4 (4.0)0.001
    Obesity (based on clinical assessment)52 (27.8)27 (31.4)25 (25)0.676
    Duration of symptoms days6.5±5.17.3±4.15.8±5.80.007
    Comorbidities
     Asthma10 (5.3)3 (3.5)7 (7.0)0.033
     Chronic cardiovascular disease44 (23.5)18 (20.9)26 (26.0)0.104
     COPD (GOLD stage >2)30 (5.3)12 (14.0)18 (18.0)0.134
     Current malignancy35 (18.7)9 (10.5)26 (26.0)<0.001
     Diabetes mellitus36 (19.3)21 (24.4)15 (15.0)0.001
    Laboratory analysis on admission
     CRP mg·L−1 median (interquartile range)59 (81.5)68 (83.8)49.0 (80.8)0.73
     Procalcitonin ng·mL−1 median (interquartile range)0.1 (0.25)0.12 (0.21)0.1 (0.37)0.004
     Positive blood culture12 (6.4)1 (1.2)11 (11.0)0.204
     Positive influenza A/B0000.593
    Observations
     Modified early warning score (MEWS)2.6±1.82.9±1.62.3±1.80.605
     Temperature °C37.5±1.237.8±1.137.2±1.30.174
     Respiratory rate min-121.2±6.921.9±7.220.7±6.70.888
     Oxygen saturation %95.8±3.294.9(3.596.4±2.80.165
     Oxygen therapy58 (0.31)34 (39.5)24 (24.0)0.004
     Intubation9 (4.8)8 (9.3)1 (1.0)<0.001

    Data are presented as mean±sd or n (%), unless otherwise stated. Statistically significant differences between the PCR positive and PCR negative groups are emphasised in bold text. ED: emergency department; IC: intensive care; GOLD: Global Initiative for Chronic Obstructive Lung Disease; CRP: C-reactive protein. #: One patient had an indeterminate PCR and no repeat PCR, therefore the total amount of patients (187) differs from the sum of the PCR positives (86) and PCR negatives (100).

    • TABLE 2

      Diagnostic results

      PCR positivePCR negativeFinal diagnosis
      Lung ultrasound: positive792991
      Lung ultrasound: negative77110
      CT: positive7618
      CT: negative1082

      Data are presented as n. CT: computed tomography.

      • TABLE 3

        Diagnostic accuracy for COVID-19

        Lung ultrasound versus PCRCT versus PCRLung ultrasound versus COVID-19 diagnosis#
        Sensitivity % (95% CI)91.9 (84.0–96.7)88.4 (79.7–94.3)90.1 (82.5–95.2)
        Specificity % (95% CI)71.0 (61.1–79.6)82.0 (73.1–89.0)80.0 (69.9–87.9)
        Positive likelihood ratio3.2 (2.3–4.3)4.9 (3.2–7.5)4.5 (2.9–6.9)
        Negative likelihood ratio0.1 (0.06–0.24)0.14 (0.08–0.26)0.12 (0.07–0.2)
        PPV % (95% CI)73.2 (66.6–78.8)80.9 (73.4–86.6)84.2 (77.7–89.2)
        NPV % (95% CI)91.0 (83.1–95.4)89.1 (82.0–93.7)90.8 (81.7–95.6)
        Accuracy % (95% CI)80.7 (74.2–86.1)85.0 (79.0–89.8)82.8 (76.6–87.9)

        CT: computed tomography; COVID-19: coronavirus disease 2019; PPV: positive predictive value; NPV: negative predictive value; CI: confidence interval. #: According to multidisciplinary team, COVID-19 is highly likely.

        Supplementary Materials

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          Supplementary material 00539-2020.SUPPLEMENT

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        Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study
        Arthur W.E. Lieveld, Bram Kok, Frederik H. Schuit, Kaoutar Azijli, Jarom Heijmans, Arjan van Laarhoven, Natascha L. Assman, Ruud S. Kootte, Tycho J. Olgers, Prabath W.B. Nanayakkara, Frank H. Bosch
        ERJ Open Research Oct 2020, 6 (4) 00539-2020; DOI: 10.1183/23120541.00539-2020

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        Diagnosing COVID-19 pneumonia in a pandemic setting: Lung Ultrasound versus CT (LUVCT) – a multicentre, prospective, observational study
        Arthur W.E. Lieveld, Bram Kok, Frederik H. Schuit, Kaoutar Azijli, Jarom Heijmans, Arjan van Laarhoven, Natascha L. Assman, Ruud S. Kootte, Tycho J. Olgers, Prabath W.B. Nanayakkara, Frank H. Bosch
        ERJ Open Research Oct 2020, 6 (4) 00539-2020; DOI: 10.1183/23120541.00539-2020
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