Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department

Accurate diagnostic testing to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is critical. Although highly specific, SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR) has been shown in clinical practice to be affected by a noninsignificant proportio...

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Published in:	Annals of emergency medicine Vol. 77; no. 4; pp. 385 - 394
Main Authors:	Pivetta, Emanuele, Goffi, Alberto, Tizzani, Maria, Locatelli, Stefania M., Porrino, Giulio, Losano, Isabel, Leone, Dario, Calzolari, Gilberto, Vesan, Matteo, Steri, Fabio, Ardito, Arianna, Capuano, Marialessia, Gelardi, Maria, Silvestri, Giulia, Dutto, Stefania, Avolio, Maria, Cavallo, Rossana, Bartalucci, Alice, Paglieri, Cristina, Morello, Fulvio, Richiardi, Lorenzo, Maule, Milena M., Lupia, Enrico, Baldassa, Federico, Baron, Paolo, Bianchi, Giordano, V, Busso, Conterno, Andrea, Del Rizzo, Paola, Fascio Pecetto, Paolo, Giachino, Francesca, Iannaccone, Andrea, Ferrera, Patrizia, Riccardini, Franco, Sacchi, Claudia, Sozzi, Michela, Totaro, Silvia, Visconti, Pasqualina, Risi, Francesca, Basile, Francesca, Baricocchi, Denise, Beux, Alessia, Beux, Valentina, Bima, Paolo, Cara, Irene, Chichizola, Liliana, Dellavalle, Francesca, Grosso, Federico, Labarile, Giulia, Oddi, Matteo, Ottino, Marco, Pia, Ilaria, Scategni, Virginia, Surra, Astrid
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2021 by the American College of Emergency Physicians
Subjects:	Adult Aged COVID-19 - diagnosis COVID-19 - diagnostic imaging COVID-19 Nucleic Acid Testing Emergency Service, Hospital False Negative Reactions Female Humans Infectious Disease/Original Research Italy Lung - diagnostic imaging Male Middle Aged Prospective Studies SARS-CoV-2 Sensitivity and Specificity Ultrasonography Italy
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Summary:	Accurate diagnostic testing to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is critical. Although highly specific, SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR) has been shown in clinical practice to be affected by a noninsignificant proportion of false-negative results. This study seeks to explore whether the integration of lung ultrasonography with clinical evaluation is associated with increased sensitivity for the diagnosis of coronavirus disease 2019 pneumonia, and therefore may facilitate the identification of false-negative SARS-CoV-2 RT-PCR results. This prospective cohort study enrolled consecutive adult patients with symptoms potentially related to SARS-CoV-2 infection who were admitted to the emergency department (ED) of an Italian academic hospital. Immediately after the initial assessment, a lung ultrasonographic evaluation was performed and the likelihood of SARS-CoV-2 infection, based on both clinical and lung ultrasonographic findings (“integrated” assessment), was recorded. RT-PCR SARS-CoV-2 detection was subsequently performed. We enrolled 228 patients; 107 (46.9%) had SARS-CoV-2 infection. Sensitivity and negative predictive value of the clinical–lung ultrasonographic integrated assessment were higher than first RT-PCR result (94.4% [95% confidence interval {CI} 88.2% to 97.9%] versus 80.4% [95% CI 71.6% to 87.4%] and 95% [95% CI 89.5% to 98.2%] versus 85.2% [95% CI 78.3% to 90.6%], respectively). Among the 142 patients who initially had negative RT-PCR results, 21 tested positive at a subsequent molecular test performed within 72 hours. All these false-negative cases were correctly identified by the integrated assessment. This study suggests that, in patients presenting to the ED with symptoms commonly associated with SARS-CoV-2 infection, the integration of lung ultrasonography with clinical evaluation has high sensitivity and specificity for coronavirus disease 2019 pneumonia and it may help to identify false-negative results occurring with RT-PCR.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 All members are listed in the Appendix.
ISSN:	0196-0644 1097-6760
DOI:	10.1016/j.annemergmed.2020.10.008