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Utility of Lung Ultrasound in Decision Making to Prioritize Hospital Admission for COVID-19 patients: A Developing Country Perspective

Author(s):

Samy Zaky, Mohamed A. Metwally, Mohamed El Badry, Ali A Hasan, Sherief Abd-Elsalam*, Fathiya El-Raey, Alshaimaa Eid, Mohamed Alboraie, Mohamed Elbahnasawy, Atef Wahdan Elrefai, Alya A. Elnaggar, Ehab F. Moustafa, Ahmed Abdelaziz, Amin Abdel Baki, Gehan Elassal, Akram Abdelbary, Ahmad Said Abdalmohsen, Ehab Kamal, Noha Asem, Hamdy Ibrahim, Khaled Taema, Wagdy Amin, Fatma M. Kotb, Ahmed Sh. Mohamed, Neamat A. Abdelmageed, Mohamed Elnady, Hossam Hosny Masoud, Mohamed Hassany and Hala Zaid  

Abstract:


Background & Aims: In healthcare settings with limited resources, it is crucial to make a plan to prioritize hospital admission for patients affected by COVID-19. So, we tried to develop a novel approach for triaging COVID-19 patients and deciding the priority for hospital admission using Lung Ultrasound. In this study, we aimed to evaluate the efficacy of lung ultrasound in triaging suspected COVID-19 patients and assessment of the severity of COVID-19 pneumonia and its comparison with CT chest as the gold standard.

Method: This was a multicenter cross-sectional study enrolled on 243 COVID-19 confirmed patients presented to the emergency department in three major University hospitals in Egypt. Lung ultrasound was done by an experienced emergency physician or chest physician according to the local protocol of each hospital. Demographic, clinical, and laboratory data were collected from each patient. Each patient was subjected to CT chest and lung ultrasound.

Results: A total of 243 confirmed COVID-19 patients were enrolled in this study, with a mean age of 46.7+10.4 years. Ground glass opacity (GGO), subpleural consolidation, trans-lobar consolidation, and crazy paving were reported in chest CT scans of 54.3%, 15.2%, 11.1%, and 8.6% of patients, respectively. B-line artifacts were found in 81.1% of COVID-19 patients, which was of confluent pattern in 18.9% of patients. The lung ultrasound findings of 197 patients (81.1%) were completely coincident with those of CT with a Kappa agreement value of 0.77, and this offered a diagnostic sensitivity of 74 %, a diagnostic specificity of 97.9 %, positive predictive value (PPV) of 90.2% and negative predictive value (NPV) of 93.6 % for lung ultrasound in triaging COVID-19 patients. Adding O2 saturation to the findings of lung imaging, the accuracy of evaluation of lung ultrasound to differentiate between severe and non-severe lung diseases showed that ultrasound had 100% sensitivity and specificity.

Conclusion: Lung Ultrasound with Oxygen saturation is a very efficient tool for decision-making to prioritize hospital admission for patients affected by COVID-19 in healthcare settings with limited resources.

Keywords:

COVID-19, Lung, Ultrasound, Triage, Oxygen, Pneumonia

Affiliation:

Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Hepatology, Gastroenterology and Infectious Diseases Department, Benha University, Benha, Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Department of Chest Diseases and Tuberculosis, Assiut University Hospital, Tropical Medicine Department, Tanta University, Tanta, Department of Hepatogastroenterology and Infectious diseases, Al-Azhar University, Damietta, Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Department of Internal Medicine, Al-Azhar University, Cairo, Emergency Medicine and Traumatology Department, Tanta University Faculty of medicine, Tanta, Department of Chest Diseases, Damietta Faculty of Medicine, Al-Azhar, University, Cairo, Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Department of Tropical Medicine and Gastroenterology, Assiut University, Assiut , Department of Hepatogastroenterology and Infectious diseases, Al-Azhar University, Damietta, Department of Hepatology National Hepatology and Tropical Medicine Research Institute, Cairo , Professor of pulmonology, Ain Shams University, Cairo, Critical Care Medicine, Cairo University, Cairo, Faculty of Medicine, Cairo University, Cairo, Medical Research Division. National Research Centre, Giza, Ministry of Health and Population and Faculty of Medicine, Cairo University, Department of Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo , Critical Care Medicine, Cairo University, Cairo, Director General for Chest Diseases, MOHP, Cairo, Lecturer of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Professor of Chest Diseases and Bronchscopy, Tanta, University, Tanta, Hepatogastroenterology and Infectious Diseases, Al-Azhar University, Cairo, Professor of Pulmonology, Cairo University, Cairo, Professor of Pulmonology, Cairo University, Cairo, Department of Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, Professor of Pulmonology, Cairo University, Cairo



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