Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

Background: Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain. Objectives: The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings. Methods: Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities. Results: All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible -abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r = -0.66, p < 0.001). Conclusion: When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings

Chest ultrasound for the diagnosis of acute respiratory diseases in frail multimorbid hospitalized elderly

Objectives– To compare the diagnostic accuracy of bedside chest ultrasound vs chest X-ray in a cohort of frail multimorbid elderly acutely hospitalized with respiratory symptoms. Methods– 97 frail (Rockwood score≥4) multimorbid (≥3 chronic comorbidities) elderly (age≥65, median 84, IQR 78-89) admitted to an acute-care geriatric ward with sudden-onset respiratory complaints (cough, dyspnea, hemoptysis, pleuritic pain) were consecutively evaluated with a standard chest X-ray, carried out in a radiology unit, and a bedside chest ultrasound, performed by clinicians of the admitting ward. Chest contrast-enhanced CT was performed only if other tests’ results were inconclusive. Ultrasound and X-ray results were blindly categorized as positive or negative by an expert clinician. Diagnostic accuracy, sensitivity and sensibility of chest ultrasound and X-ray for the main diagnoses (i.e. heart failure, pneumonia, pleural effusion) were calculated. Results- Overall diagnostic accuracy for pneumonia (46 patients) was higher for ultrasound (92%vs72%), that proved more sensitive than X-ray (92%vs53%) and similarly specific (98%vs94%). Similar results were also obtained for pleural effusion (21 patients, accuracy 94% ultrasound vs 67% X-ray, sensitivity 97%vs59%, specificity 96%vs96%), but not for heart failure, where diagnostic performance was equal (accuracy 84%vs83%, sensitivity 69%vs67%, specificity 97%vs97%). Chest CT was necessary for diagnosis only in 17% of cases, while in 44 cases out of 97 (45%) ultrasound allowed to establish diagnosis despite negative X-ray, thus preventing a CT prescription. Conclusions- Bedside chest ultrasound can be an accurate and effective part of diagnostic workup for frail multimorbid elderly with respiratory symptoms, improving appropriateness in chest CT prescriptions

Application of The Sepsis-3 Consensus Criteria in a Geriatric Acute Care Unit: A Prospective Study

The prognostic value of quick Sepsis-related Organ Failure Assessment (qSOFA) score in geriatric patients is uncertain. We aimed to compare qSOFA vs. Systemic Inflammatory Response Syndrome (SIRS) criteria for mortality prediction in older multimorbid subjects, admitted for suspected sepsis in a geriatric ward. We prospectively enrolled 272 patients (aged 83.7 ± 7.4). At admission, qSOFA and SIRS scores were calculated. Mortality was assessed during hospital stay and three months after discharge. The predictive capacity of qSOFA and SIRS was assessed by calculating the Area Under the Receiver Operating Characteristic Curve (AUROC), through pairwise AUROC comparison, and multivariable logistic regression analysis. Both qSOFA and SIRS exhibited a poor prognostic performance (AUROCs 0.676, 95% CI 0.609–0.738, and 0.626, 95% CI 0.558–0.691 for in-hospital mortality; 0.684, 95% CI 0.614–0.748, and 0.596, 95% CI 0.558–0.691 for pooled three-month mortality, respectively). The predictive capacity of qSOFA showed no difference to that of SIRS for in-hospital mortality (difference between AUROCs 0.05, 95% CI −0.05 to 0.14, p = 0.31), but was superior for pooled three-month mortality (difference between AUROCs 0.09, 95% CI 0.01–0.17, p = 0.029). Multivariable logistic regression analysis, accounting for possible confounders, including frailty, showed that both scores were not associated with in-hospital mortality, although qSOFA, unlike SIRS, was associated with pooled three-month mortality. In conclusion, neither qSOFA nor SIRS at admission were strong predictors of mortality in a geriatric acute-care setting. Traditional geriatric measures of frailty may be more useful for predicting adverse outcomes in this setting