News | Coronavirus (COVID-19) | February 11, 2021

Lung Ultrasound Helps Predict COVID-19 Patient Outcomes

Brazilian researchers applied an examination protocol based on an analysis of 12 lung regions to 180 severe patients and found that the higher the lung ultrasound score the greater the risk of ICU admission, intubation and death

Brazilian researchers found that the higher the lung ultrasound score the greater the risk of ICU admission, intubation and death. Image courtesy of Julio Alencar

Brazilian researchers found that the higher the lung ultrasound score the greater the risk of ICU admission, intubation and death. Image courtesy of Julio Alencar

February 11, 2021 — Lung ultrasound, considered a simple method for diagnosing lung disease, can also help predict the clinical progression of severe COVID-19 patients, according to a study conducted at the University of São Paulo's Medical School (FM-USP) in São Paulo City, Brazil.

The principal investigator for the study was Heraldo Possolo de Souza, a professor at FM-USP and an attending physician at its teaching and general hospital, Hospital das Clínicas (HC).

The researchers applied an ultrasound examination protocol covering 12 lung regions in 180 COVID-19 patients undergoing treatment at HC. The results showed that the higher the lung ultrasound score, the greater the risk of admission to an intensive care unit (ICU), intubation, and death.

The study was supported by São Paulo Research Foundation - FAPESP and reported in an article published in Annals of Intensive Care.

"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. It can be a simple, cheap way to estimate the prognosis for patients infected by the virus," Souza said.

At the start of the pandemic, Souza and other emergency room (ER) attendings at HC and other hospitals worldwide had to process overwhelming numbers of patients with insufficient resources. In learning to tackle this challenge, which has now returned owing to the rebound in patient numbers, healthcare teams have found they must use tools to assess the severity of each case so that resources such as ICU beds and ventilators are correctly allocated and care priorities can be established.

Given the importance of diagnostic imaging of the lungs to the treatment of severe COVID-19 patients, the FM-USP group assumed it could also be useful to screen patients admitted with the infection based on predicted outcome. They chose lung ultrasound to test the hypothesis because the method is widely used in ERs, as well as being fast, easy to perform with portable equipment, and inexpensive.

"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," said Julio Cesar Garcia de Alencar, an ER attending at HC and first author of the article on the study.

Methodology

The study subjects were patients diagnosed by RT-PCR and admitted to HC between March and May 2020, in the initial stages of the pandemic. The researchers performed lung ultrasound exams on the volunteers and calculated their scores on the day of admission to the ER. The median age of the subjects was 60, and well over half (58%) were male.

The scoring methodology, known as the LUS protocol, entailed examining 12 lung regions in the anterior, lateral, and posterior aspects of the chest wall on both sides. Each region was evaluated by aeration pattern, with scores ranging from zero to 3 points according to the worst pattern observed. The final score was the sum of points in all 12 regions, ranging from zero to 36.

The results showed that patients scoring 14-16 were most likely to require ICU care, and a fatal outcome was most likely for those with scores above 20.

The average LUS was 18.7, with a standard deviation of 6.8. Of the 180 patients enrolled, 109 (60%) were discharged alive, 74 (56%) were treated in the ICU, 52 (39%) were intubated and 61 (33%) died.

"We confirmed the hypothesis that LUS helps predict ICU admission, intubation, and death in severe COVID-19 patients," Alencar said.

Higher risk of death

In another study conducted as part of the project and published in the journal PLOS ONE, the same group of researchers found that out of 506 patients with confirmed COVID-19 pneumonia admitted to the ER, 333 (65.9%) were discharged home, 153 (30.2%) died, and 20 (3.9%) remained in the hospital. A total of 300 patients (59.3%) required intensive care, and 227 (44.9%) had to be intubated. Mortality was 30.2% overall, and 55.9% for intubated patients.

"We created a group of ER physicians at HC not just to provide patient care but to work as researchers who collect data that can be used as markers to predict the outcomes of severe cases of COVID-19," Souza said.

For more information: www.fapesp.br

For more information on lung ultrasound on COVID-19 patients:

Lung Ultrasounds Could Help Determine COVID-19 Outcome

Lung Ultrasound Shows Duration, Severity of Coronavirus Disease

VIDEO: Imaging COVID-19 With Point-of-Care Ultrasound (POCUS)

VIDEO: What Does COVID-19 Look Like in Lung CT Scans 

PHOTO GALLERY: How COVID-19 Appears on Medical Imaging

VIDEO: How to Image COVID-19 and Radiological Presentations of the Virus — Interview with Margarita Revzin, M.D.,

VIDEO: Use of Teleradiology During the COVID-19 Pandemic — Interview with John Kim, M.D.

 

 

Related Content

Guerbet announced the launch of OptiProtect 3S, a new range of technical services for its injection solutions. OptiProtect 3S is designed to support imaging centers in the daily use and protection of their injection solutions.
News | Contrast Media Injectors | February 25, 2021
February 25, 2021 — Guerbet announced the launch of ...
An example of cardiac ultrasound longitudinal strain measurements on the Epsilon EchoInsight software. This can be used to assess cardiotoxicity from chemotherapy agents. 

An example of cardiac ultrasound longitudinal strain measurements on the Epsilon EchoInsight software. This can be used to assess cardiotoxicity from chemotherapy agents. 

News | Cardio-oncology | February 25, 2021
February 25, 2020 — Results of a multi-centre, international, clinical trial co-led by Peter Munk Cardiac Centre (PMC
Advanced technologies and applications such as point-of-care, pediatrics, dry-magnets, compact MRI and fusion imaging are driving global market
News | Magnetic Resonance Imaging (MRI) | February 24, 2021
February 24, 2021 — Frost & Sullivan's recent analysis, Technological Advancements and Emerging Applications in t
55-year-old woman who underwent screening mammogram and ultrasound 7 days after first COVID-19 vaccination dose. Screening mammogram and US demonstrated unilateral left axillary lymph node with cortical thickness of 5 mm on ultrasound (not shown). BI-RADS category 0 was assigned. Ultrasound from diagnostic work-up performed 7 days later showed no change in lymph node size. BI-RADS 3 was assigned. #COVIDvaccine #COVID19

55-year-old woman who underwent screening mammogram and ultrasound 7 days after first COVID-19 vaccination dose. Screening mammogram and US demonstrated unilateral left axillary lymph node with cortical thickness of 5 mm on ultrasound (not shown). BI-RADS category 0 was assigned. Ultrasound from diagnostic work-up performed 7 days later showed no change in lymph node size. BI-RADS 3 was assigned.

News | Breast Imaging | February 24, 2021
Detroit-based magnetic resonance imaging (MRI) technology company SpinTech, Inc. has acquired medical-imaging research and technology developer Magnetic Resonance Innovations, Inc. (MR Innovations).
News | Magnetic Resonance Imaging (MRI) | February 24, 2021
February 24, 2021 — Detroit-based magnetic resonance...
Findings indicate that PPC and GG are highly predictive of overall upstaging by PSMA PET/CT for patients with high-risk prostate cancer

Image courtesy of UCLA Health

News | PET-CT | February 23, 2021
February 23, 2021 — A...
Axial FLAIR MR image shows T2 prolongation in bilateral middle cerebellar peduncles (arrows). Findings were associated with restricted diffusion and areas of T1 hypointense signal without enhancement or abnormal susceptibility. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

Axial FLAIR MR image shows T2 prolongation in bilateral middle cerebellar peduncles (arrows). Findings were associated with restricted diffusion and areas of T1 hypointense signal without enhancement or abnormal susceptibility. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

News | Coronavirus (COVID-19) | February 22, 2021
February 22, 2021 — According to an...
Examples of the imaging performance of XPCI-CT (b,e) compared to conventional specimen radiography (a,d) and benchmarked against histopathology (c,f). he top row focuses on the similarity between the XPCI-CT slice in (b) and the histological slice in (c). Arrow 1 indicates margin involvement, arrow 2 a variation in density in the internal structure of the tumour mass, arrow 3 tumour-induced inflammation. All this is confirmed by the histological slice in (c), and hardly visible in the conventional image in

Examples of the imaging performance of XPCI-CT (b,e) compared to conventional specimen radiography (a,d) and benchmarked against histopathology (c,f). he top row focuses on the similarity between the XPCI-CT slice in (b) and the histological slice in (c). Arrow 1 indicates margin involvement, arrow 2 a variation in density in the internal structure of the tumour mass, arrow 3 tumour-induced inflammation. All this is confirmed by the histological slice in (c), and hardly visible in the conventional image in (a). The bottom row focuses on the detection of small calcifications, a key feature in DCIS. These are undetectable in (d), detected in (e), enhanced in the maximum intensity projection (MIP) image at the bottom of (f), and confirmed by histopathology in the top part of (f). The scale bar [shown in (b) and (e)] is the same for all images apart from (f), which has its own scale. Red arrows in (e) and (f) indicate the microcalcifications. Image courtesy of Professor Alessandro Olivo

News | Breast Imaging | February 22, 2021
February 22, 2021 — A new X-ray imaging scanne