Abstract
Background In this COVID-19 pandemic, fast and accurate testing is needed to profile patients at the emergency department (ED) and efficiently allocate resources. Chest imaging has been considered in COVID-19 workup, but evidence on lung ultrasound (LUS) is sparse. We therefore aimed to assess and compare the diagnostic accuracy of LUS and computed tomography (CT) in suspected COVID-19 patients.
Methods This multi-centre, prospective, observational study included adult patients with suspected COVID-19 referred to internal medicine at the ED. We calculated diagnostic accuracy measures for LUS and CT using both PCR and multi-disciplinary team (MDT) diagnosis as reference. We also assessed agreement between LUS and CT, and between sonographers.
Results Between March 19 and May 4, 2020, 187 patients were included. Area under the receiver operating characteristic (AUROC) was 0.81 (CI 0.75–0.88) for LUS and 0.89 (CI 0.84–0.94) for CT. Sensitivity and specificity for LUS were 91.9% (CI 84.0–96.7) and 71.0% (CI 61.1–79.6), versus 88.4% (CI 79.7–94.3) and 82.0% (CI 73.1–89.0) for CT. Negative likelihood ratio was 0.1 (CI 0.06–0.24) for LUS and 0.14 (0.08–0.3) for CT. No patient with a false negative LUS, required supplemental oxygen or admission. LUS specificity increased to 80% (CI 69.9–87.9) compared to MDT diagnosis, with an AUROC of 0.85 (CI 0.79–0.91). Agreement between LUS and CT was 0.65. Inter-observer agreement for LUS was good: 0.89 (CI 0.83–0.93).
Conclusion LUS and CT have comparable diagnostic accuracy for COVID-19 pneumonia. LUS can safely exclude clinically relevant COVID-19 pneumonia and may aid COVID-19 diagnosis in high prevalence situations.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Lieveld has nothing to disclose.
Conflict of interest: Dr. Kok has nothing to disclose.
Conflict of interest: Dr. Schuit has nothing to disclose.
Conflict of interest: Dr. Azijli has nothing to disclose.
Conflict of interest: Dr. Heijmans has nothing to disclose.
Conflict of interest: Dr. van Laarhoven has nothing to disclose.
Conflict of interest: Dr. Assman has nothing to disclose.
Conflict of interest: Dr. Kootte has nothing to disclose.
Conflict of interest: Dr. Olgers has nothing to disclose.
Conflict of interest: Dr. Nanayakkara has nothing to disclose.
Conflict of interest: Dr. Bosch has nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received July 30, 2020.
- Accepted September 30, 2020.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.