Portable pulmonary ultrasound for the diagnosis of COVID-19 pneumonia

Description of the Study:

• Title: Lung ultrasound is a reliable diagnostic technique to predict abnormal CT chest scan and to detect oxygen requirements in COVID-19 pneumonia.
• Principal investigators: Géraldine Falgarone and Olivier Seror. 
• Co-investigators: Frédéric Pamoukdjian, Johann Cailhol, Audrey Giocanti-Auregan, Sandrine Guis, Guilhem Bousquet and Olivier Bouchaud.
• Centers of Implementation: Paris Seine-Saint-Denis University Hospitals, Université Sorbonne Paris Nord and Avicenne AP-HP hospital.
• Study Population: 50 consecutive patients with an average age of 54 and hospitalized with COVID-19 pneumonia between March and April 2020. All patients had a chest CT scan and a pulmonary ultrasound upon entry into the study.
• Methods: Daily lung ultrasonography (LUS) evaluations were performed using a portable device to evaluate COVID-19 pneumonia. LUS evaluations of lung damage were graded in the six categories described for ARDS, in a blinded manner for oxygen needs and CT scan grading, based on a twelve point grading system. This severity index that is based on evaluations done with certainty to be able to take into account missing data and feasibility.
  

Objectives of the Study:

Principal Objective: To assess the diagnostic performance of LUS as compared to CT chest scan for the diagnosis of COVID-19 pneumonia and assessment of oxygen requirements by LUS.

More about this Study:

Scientific Context: COVID-19 pneumonia can be severe and its evolution unpredictable with a high mortality prevalence of 26% in older inpatients. Computed Tomography (CT) chest scan is the imaging “gold standard” to detect COVID-19 pneumonia, in particular when RT-PCR is negative. In the dramatic context of a pandemic situation, access to CT chest scan can be limited, and repeated CT scans, if an imaging follow-up is required, can be difficult to perform due to costs, invasiveness and infectious risks. In intensive care units, lung ultrasonography (LUS) has proved to be very helpful in managing acute respiratory distress syndrome, (ARDS), and has recently been suggested to manage COVID-19 pneumonia.

Conclusions: This proof-of-concept study proposes an original scoring system and a severity index requires confirmation by larger multicentre studies, which can now benefit from a clearly described, easy procedure. This would help in evaluating lung disease using ultrasound in a clinical practice also named ultrasonoscopy.