1. Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department
- Author
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Cristina Paglieri, Stefania M. Locatelli, Giulio Porrino, Andrea Conterno, Alessia Beux, Maria Avolio, Michela Sozzi, Dario Leone, Pasqualina Visconti, Claudia Sacchi, Ilaria Pia, Silvia Totaro, Astrid Surra, Francesca Risi, Francesca Dellavalle, Federico Grosso, Paolo Baron, Gilberto Calzolari, Fabio Steri, Francesca Basile, Alberto Goffi, Marialessia Capuano, Emanuele Pivetta, Francesca Giachino, Franco Riccardini, Patrizia Ferrera, Andrea Iannaccone, Busso, Alice Bartalucci, Rossana Cavallo, Paolo Fascio Pecetto, Isabel Losano, Lorenzo Richiardi, Paola Del Rizzo, Giulia Silvestri, Marco Ottino, Liliana Chichizola, Arianna Ardito, Matteo Oddi, Paolo Bima, Valentina Beux, Maria Gelardi, Giordano Bianchi, Fulvio Morello, Denise Baricocchi, Irene Cara, Enrico Lupia, Matteo Vesan, Federico Baldassa, Maria Tizzani, Virginia Scategni, Milena Maule, Stefania Dutto, and Giulia Labarile
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Adult ,Male ,medicine.medical_specialty ,Lung ultrasonography ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Sensitivity and Specificity ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,False Negative Reactions ,Lung ,Aged ,Ultrasonography ,business.industry ,SARS-CoV-2 ,COVID-19 ,030208 emergency & critical care medicine ,Emergency department ,Middle Aged ,medicine.disease ,Confidence interval ,respiratory tract diseases ,Pneumonia ,medicine.anatomical_structure ,Italy ,COVID-19 Nucleic Acid Testing ,Emergency Medicine ,Female ,business ,Emergency Service, Hospital - Abstract
Study objective 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. Methods 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. Results 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. Conclusion 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.
- Published
- 2021
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