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Predicting COVID-19 Outcomes With Lung Ultrasound

Proper assessment of the severity and extent of pulmonary involvement is of paramount importance.

A recent study conducted by investigators from the University of São Paulo's Medical School has discovered that a simple lung ultrasound can aid in predicting the clinical progression of patients with a serve form of the coronavirus disease 2019 (COVID-19). Results from the study were published in the journal Annals of Intensive Care.

Investigators behind the prospective cohort study applied ultrasound examinations to 180 patients who had a confirmed case of COVID-19 and were in the intensive care unit (ICU) at the Hospital das Clinicas da Universidade de São Paulo. The patients had a mean age of 60 years old and 58% of them were male.

A score was calculated for each of the participants using a methodology called the LUS protocol. This consisted of evaluating 12 different lung regions in the anterior, lateral and posterior, on aeration patterns and giving them a score from 0 to 3. A final score was then created from the sum of all points ranging from 0 to 36.

Findings demonstrated that of the 180 patients enrolled, 109 were discharged alive, 74 were treated in the ICU, 52 were intubated and 61 died. Those with a score of 14-16 were most likely to require care in an ICU and for those with a score of 20 or above, a fatal outcome was more likely. The average score was 18.7, with a standard deviation of 6.8

"We found lung ultrasound to be a good predictor of the need for intensive care with endotracheal intubation and the risk of death for COVID-19 patients admitted to the emergency room,” Heraldo Possolo de Souza, a professor at FM-USP and an attending physician at its teaching and general hospital said. “It can be a simple, cheap way to estimate the prognosis for patients infected by the virus.”

Due to the pandemic creating an overwhelming problem for clinics and hospitals due to increased numbers of patients with the virus, there have been insufficient recourses to properly treat everyone. Using tools that can help to assess case severity can allow recourses to be properly allocated, alleviating the burden hospitals have been dealing with.

"Point-of-care lung ultrasound is extremely important in the pandemic. It can be performed at the bedside by ER staff who don't need to be as highly trained to interpret the images as they do in the case of a chest CT scan, for example," Julio Cesar Garcia de Alencar, an ER attending at HC and first author of the article on the study said.