ABSTRACT
Background:
Chest imaging, including
chest X-ray (CXR) and computed
tomography (CT), can be a helpful adjunct to
nucleic acid test (NAT) in the
diagnosis and management of Coronavirus Disease 2019 (COVID-19).
Lung point of care ultrasound (POCUS), particularly with handheld
devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-
resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19
pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19
pneumonia.
Purpose:
To assess the diagnostic performance of a standardized
lung POCUS protocol using a handheld POCUS
device to detect
patients with either a positive NAT or a COVID-19-typical pattern on CT scan.
Methods:
Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve
lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol.
Patients were divided into low, intermediate, and high suspicion based on their POCUS score.
Results:
Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (
AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a
sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a
specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively.
Conclusions:
The proposed
lung POCUS protocol with a handheld
device showed reasonable diagnostic performance to detect
inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-
resource settings, POCUS with handheld
devices may serve as a helpful adjunct for
persons under investigation for COVID-19
pneumonia.
