Acil Servise Başvuran COVID-19 Hastalarında Akciğer Ultrasonografisinin Tanısal Değeri

Yıl 2024, Cilt: 9 Sayı: 2, 57 - 65, 16.08.2024

İbrahim Sarbay , Halil Doğan

https://doi.org/10.55694/jamer.1474004

Öz

Amaç: Acil servise (AS) COVID-19 düşündüren semptomlarla başvuran hastalarda akciğerlerin ultrasonografik değerlendiril-
mesinin, COVID-19 pnömonisi açısından tanısal değerinin olup olmadığının araştırılması amaçlandı.
Gereç ve Yöntemler: Prospektif, kesitsel, gözlemsel bir çalışma olarak Bakırköy Dr Sadi Konuk Eğitim ve Araştırma Hastanesi
Acil Tıp Kliniği’nde 2 aylık periyotta gerçekleştirildi. Çalışmaya COVID-19’u düşündüren semptomlarla başvuran toplam 204
yetişkin hasta dahil edildi. Akciğer Ultrasonografisi (LUS) ve Toraks Bilgisayarlı Tomografisinden (BT) elde edilen bulgular
ve sonuçlar toplandı.
Bulgular: 112 hastanın Toraks BT bulguları COVID-19 pnömonisi ile uyumluydu. Bunların 104’ü (%92,86) “LUS pozitif” idi.
LUS’un COVID-19 tanısında duyarlılığı %93,33, özgüllüğü %80, Pozitif Prediktif Değeri %82,96, Negatif Prediktif Değeri
ise %92 olarak belirlendi. Düzensiz B çizgileri en hassas LUS bulgusuydu. İki farklı COVID-19 LUS skoru için ROC analizi
yapıldı: Hasta grubunda “LUS skoru”nun 13’ün üzerinde olmasının 14 günlük mortalite açısından duyarlılığı %80, özgüllüğü
ise %52,63 idi. “Toplam LUS Skoru”nun 13’ün üzerinde olmasının ise 14 günlük mortalite için duyarlılığı %79,46, özgüllüğü
ise %57,89 idi.
Sonuç: LUS, acil tıp hekimine COVID-19’da triyaj ve klinik karar vermede yardımcı olabilir. COVID-19 “Toplam LUS Sko-
ru”nun, “LUS Skoru”na göre daha iyi özgüllüğe ve benzer duyarlılığa sahip olduğu ve her ikisinin de kötü klinik sonuçlarla
ilişkili olduğu görüldü. Düzensiz B çizgileri (%89,3) ve Plevral Kalınlaşma (%63,4) LUS’ta en sık görülen COVID-19 ile ilgili
bulgulardır. COVID-19 şüphesi olan hastalarda bu iki bulgunun aranması önerilir.

Anahtar Kelimeler

COVID-19, Pnömoni, Ultrasonografi

Diagnostic Value of Lung Ultrasonography in COVID-19 Patients Admitted to the Emergency Department

Öz

Aim: The aim of this study was to investigate the diagnostic value of ultrasonographic evaluation of the lungs for COVID-19
pneumonia in patients admitted to the emergency department (ED) with suggestive symptoms.
Materials and Methods: A prospective, cross-sectional, observational study was conducted in the ED of Bakirkoy Dr. Sadi
Konuk Training and Research Hospital over a 2-month period. A total of 204 adult patients presenting with symptoms suggestive
of COVID-19 were included. Data from Lung Ultrasonography (LUS) and Thorax Computed Tomography (CT) were collected
for analysis.
Results: 112 patients had thoracic CT findings consistent with COVID-19 pneumonia. 104 (92.86%) were “LUS positive”. The
sensitivity of LUS was 93.33%, and specificity was 80%. The positive predictive value was 82.96%, and the negative predictive
value was 92%. Patchy B-lines were the most sensitive LUS finding. ROC analysis was performed for two COVID-19 LUS scores:
In the patient group, an “LUS score” above 13 had an 80% sensitivity and 52.63% specificity in terms of 14-day mortality. Also,
a “Total LUS Score” above 13 had a sensitivity of 79.46% and specificity of 57.89% for 14-day mortality.
Conclusion: LUS can assist emergency physicians in triage and clinical decision-making for COVID-19. The total LUS Score
offers better specificity and similar sensitivity compared to both, which were associated with poor clinical outcomes. Patchy
B-lines (89.3%) and pleural thickening (63.4%) are the most common COVID-19-related findings in LUS. It is recommended to
specifically look for these two findings in patients suspected of having COVID-19.

Anahtar Kelimeler

COVID-19, pneumonia, ultrasonography

Kaynakça

• 1. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DKW, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Eurosurveillance. 2020;25(3):1-8.
• 2. Vetrugno L, Bove T, Orso D, Barbariol F, Bassi F, Boero E, et al. Our Italian experience using lung ultrasound for identification, grading and serial follow-up of severity of lung involvement for management of patients with COVID-19. Echocardiography. 2020;37(4):625- 627.
• 3. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296(2):E115-E117.
• 4. Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology. 2020;295(1):22- 23.
• 5. Vetrugno L, Baciarello M, Bignami E, Bonetti A, Saturno F, Orso D, et al. The “pandemic” increase in lung ultrasound use in response to Covid-19: can we complement computed tomography findings? A narrative review. Ultrasound J. 2020;12(1):39.
• 6. Dogan H, Temel A. Diagnostic value of pulsed wave doppler in pneumothorax: a prospective study. Ir J Med Sci. 2024;193(2):1025- 1031.
• 7. Blaivas M. Lung ultrasound in evaluation of pneumonia. Journal of Ultrasound in Medicine. 2012;31(6):823-826.
• 8. Gülpınar B, Peker E. Computed tomography findings of viral pneumonia: Is it possible to predict the virus type depending on chest CT findings. Ankara Medical Journal. 2019;19(3).
• 9. Long L, Zhao HT, Zhang ZY, Wang GY, Zhao HL. Lung ultrasound for the diagnosis of pneumonia in adults. Medicine. 2017;96(3):e5713.
• 10. Cortellaro F, Colombo S, Coen D, Duca PG. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emergency Medicine Journal. 2012;29(1):19-23.
• 11. Yang Y, Zhang D, Zhou C, Huang H, Wang R. Value of lung ultrasound for the diagnosis of COVID-19 pneumonia: a protocol for a systematic review and meta-analysis. BMJ Open. 2020;10(8):e039180.
• 12. Kim DJ, Jelic T, Woo MY, Heslop C, Olszynski P. Just the Facts: Recommendations on point-of-care ultrasound use and machine infection control during the coronavirus disease 2019 pandemic. CJEM. 2020;22(4):445-449.
• 13. Volpicelli G, Lamorte A, Villén T. What’s new in lung ultrasound during the COVID-19 pandemic. Intensive Care Med. 2020;46(7):1445-1448.
• 14. Volpicelli G, Gargani L. Sonographic signs and patterns of COVID-19 pneumonia. Ultrasound Journal. 2020;12(1):20-22.
• 15. Piscaglia F, Stefanini F, Cantisani V, Sidhu PS, Barr R, Berzigotti A, et al. Benefits, Open questions and challenges of the use of ultrasound in the COVID-19 pandemic era. The views of a panel of worldwide international experts. Ultraschall in Der Medizin. 2020;41(3):228-236.
• 16. Soldati G, Smargiassi A, Inchingolo R, Buonsenso D, Perrone T, Briganti DF, et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: A simple, quantitative, reproducible method. J Ultrasound Med. 2020;39(7):1413-1419.
• 17. Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus statement on reporting chest CT findings related to COVID-19. Endorsed by the society of thoracic radiology, the american college of radiology, and RSNA. Radiol Cardiothorac Imaging. 2020;2(2):e200152.
• 18. Revel MP, Parkar AP, Prosch H, Silva M, Sverzellati N, Gleeson F, et al. Revel MP, Parkar AP, Prosch H, et al. COVID-19 patients and the radiology department - advice from the European Society of Radiology (ESR) and the Eropean Society of Thoracic Imaging (ESTI). Eur Radiol. 2020;30(9):4903-4909.
• 19. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: Glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722.
• 20. Marco A, Alberto P, Martina G, Andrea A, Marco D, Anna O, et al. Lung ultrasound may support diagnosis and monitoring of COVID-19 pneumonia. Ultrasound Med Biol. 2020;46(11):2908- 2917.
• 21. Rodrigues JCL, Hare SS, Edey A, Devaraj A, Jacob J, Johnstone A, et al. An update on COVID-19 for the radiologist - A British society of thoracic imaging statement. Clin Radiol. 2020;75(5):323-325.
• 22. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in Coronavirus Disease-19 (COVID-19): Relationship to duration of infection. Radiology. 2020;295(3):200463.
• 23. Han X, Cao Y, Jiang N, Chen Y, Alwalid O, Zhang X, et al. Novel Coronavirus Disease 2019 (COVID-19) pneumonia progression course in 17 discharged patients: Comparison of clinical and ThinSection Computed Tomography features during recovery. Clinical Infectious Diseases. 2020;71(15):723-731.
• 24. Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in nanjing, China. Sci China Life Sci. 2020;63(5):706-711.
• 25. Sezgin C, Gunalp M, Genc S, Acar N, Ustuner E, Oguz AB, et al. Diagnostic value of bedside lung ultrasonography in pneumonia. Ultrasound Med Biol. 2020;46(5):1189-1196.
• 26. Unlukaptan I, Dogan H, Ozucelik D. Lung ultrasound for the diagnosis of pneumonia in adults. J Pak Med Assoc. 2020;70(6):989- 992.
• 27. Lu W, Zhang S, Chen B, Chen J, Xian J, Lin Y, et al. A clinical study of noninvasive assessment of lung lesions in patients with Coronavirus Disease-19 (COVID-19) by bedside ultrasound. Ultraschall in Der Medizin. 2020;41(3):300-307.
• 28. Bonadia N, Carnicelli A, Piano A, Buonsenso D, Gilardi E, Kadhim C, et al. Lung ultrasound findings are associated with mortali ty and need for ıntensive care admission in COVID-19 patients evaluated in the emergency department. Ultrasound Med Biol. 2020;46(11):2927-2937.
• 29. Benchoufi M, Bokobza J, Anthony Chauvin A, Dion E, Baranne ML, Levan F, et al. Comparison between lung ultrasonography score in the emergency department and clinical outcomes of pa tients with or with suspected COVID-19: An observational multicentric study. J Ultrasound Med. 2023;42(12):2883-2895.
• 30. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715-721.
• 31. Wu J, Wu X, Zeng W, Guo D, Fang Z, Chen L, et al. Chest CT findings in patients with coronavirus disease 2019 and its relationship with clinical features. Invest Radiol. 2020;55(5):257-261.
• 32. Ye X, Xiao H, Chen B, Zhang SY. Accuracy of lung ultrasonography versus chest radiography for the diagnosis of adult communityacquired pneumonia: Review of the literature and meta-analysis. PLoS One. 2015;10(6):1-9.
• 33. Castro-Sayat M, Colaianni-Alfonso N, Vetrugno L, Olaizola, G, Benay, C, Herrera, F, et al. Lung ultrasound score predicts outcomes in patients with acute respiratory failure secondary to COVID-19 treated with non-invasive respiratory support: a prospective cohort study. Ultrasound J. 2024;16(1):20.
• 34. Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, et al. Lung ultrasound in critically ill patients: Comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488-1493.