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Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, Lorenzo Navarro MD, Nackers F, Stratta E, Lanusse C, Huerga H. Evaluation of a Lung Ultrasound Score in Hospitalized Adult Patients with COVID-19 in Barcelona, Spain. J Clin Med 2024; 13:3282. [PMID: 38892993 PMCID: PMC11172895 DOI: 10.3390/jcm13113282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes. Methods: We conducted a single-centre prospective study (August 2020-April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64-0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38-20.4), ICU admission (OR 3.50; 95%CI: 1.37-8.94) and need for IMV (OR 3.31; 95%CI: 1.19-9.13). Conclusions: Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
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Affiliation(s)
| | | | | | | | | | | | | | - Erin Stratta
- Médecins Sans Frontières, New York, NY 10006, USA
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2
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Delle Sedie A, Terslev L, Bruyn GAW, Cazenave T, Chrysidis S, Diaz M, Di Carlo M, Frigato M, Gargani L, Gutierrez M, Hocevar A, Iagnocco A, Juche A, Keen H, Mandl P, Naredo E, Mortada M, Pineda C, Karalilova R, Porta F, Ravagnani V, Scirè C, Serban T, Smith K, Stoenoiu MS, Tardella M, Torralba K, Wakefield R, D'Agostino MA. Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group. Semin Arthritis Rheum 2024; 65:152406. [PMID: 38401294 DOI: 10.1016/j.semarthrit.2024.152406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
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Affiliation(s)
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - George A W Bruyn
- Reumakliniek Lelystad, Lelystad, and Tergooi Hospital, Hilversum, the Netherlands
| | - Tomas Cazenave
- Instituto de Rehabiltacion Psicofisca, Buenos Aires, Argentina
| | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Esbjerg Hospital, Denmark
| | - Mario Diaz
- Fundacion Santa Fe de Bogotá, Bogotà, Colombia
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | - Marilena Frigato
- S.C. Allergologia, Immunologia e Reumatologia, ASST "Carlo Poma" Mantova, Mantova, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche - AO Mauriziano di Torino, Università di Torino, Turin, Italy
| | - Aaron Juche
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Helen Keen
- Department of Medicine and Pharmacology, University of Western Australia, Murdoch, Perth, WA, Australia
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Fundación Jiménez Díaz, Madrid, Spain
| | - Mohamed Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Carlos Pineda
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rositsa Karalilova
- Medical University of Plovdiv, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Santa Maria Maddalena Hospital, Rovigo, Italy
| | | | - Carlo Scirè
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | | | - Kate Smith
- NIHR Leeds Biomedical Research Centre and University of Leeds, UK
| | - Maria S Stoenoiu
- Rheumatology Department, Clinique Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marika Tardella
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | | | | | - Maria Antonietta D'Agostino
- Rheumatology division, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
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3
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Zeng EZ, Ebadi A, Florea A, Wong A. COVID-Net L2C-ULTRA: An Explainable Linear-Convex Ultrasound Augmentation Learning Framework to Improve COVID-19 Assessment and Monitoring. SENSORS (BASEL, SWITZERLAND) 2024; 24:1664. [PMID: 38475199 DOI: 10.3390/s24051664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
While no longer a public health emergency of international concern, COVID-19 remains an established and ongoing global health threat. As the global population continues to face significant negative impacts of the pandemic, there has been an increased usage of point-of-care ultrasound (POCUS) imaging as a low-cost, portable, and effective modality of choice in the COVID-19 clinical workflow. A major barrier to the widespread adoption of POCUS in the COVID-19 clinical workflow is the scarcity of expert clinicians who can interpret POCUS examinations, leading to considerable interest in artificial intelligence-driven clinical decision support systems to tackle this challenge. A major challenge to building deep neural networks for COVID-19 screening using POCUS is the heterogeneity in the types of probes used to capture ultrasound images (e.g., convex vs. linear probes), which can lead to very different visual appearances. In this study, we propose an analytic framework for COVID-19 assessment able to consume ultrasound images captured by linear and convex probes. We analyze the impact of leveraging extended linear-convex ultrasound augmentation learning on producing enhanced deep neural networks for COVID-19 assessment, where we conduct data augmentation on convex probe data alongside linear probe data that have been transformed to better resemble convex probe data. The proposed explainable framework, called COVID-Net L2C-ULTRA, employs an efficient deep columnar anti-aliased convolutional neural network designed via a machine-driven design exploration strategy. Our experimental results confirm that the proposed extended linear-convex ultrasound augmentation learning significantly increases performance, with a gain of 3.9% in test accuracy and 3.2% in AUC, 10.9% in recall, and 4.4% in precision. The proposed method also demonstrates a much more effective utilization of linear probe images through a 5.1% performance improvement in recall when such images are added to the training dataset, while all other methods show a decrease in recall when trained on the combined linear-convex dataset. We further verify the validity of the model by assessing what the network considers to be the critical regions of an image with our contribution clinician.
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Affiliation(s)
- E Zhixuan Zeng
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ashkan Ebadi
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Digital Technologies Research Centre, National Research Council Canada, Toronto, ON M5T 3J1, Canada
| | - Adrian Florea
- Department of Emergency Medicine, McGill University, Montreal, QC H4A 3J1, Canada
| | - Alexander Wong
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Waterloo Artificial Intelligence Institute, Waterloo, ON N2L 3G1, Canada
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4
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Griffin I, Kundalia R, Steinberg B, Prodigios J, Verma N, Hochhegger B, Mohammed TL. Evaluating Acute Pulmonary Changes in Coronavirus Disease 2019: A Comparative Analysis of Computed Tomography, Chest Radiography, Lung Ultrasound, Magnetic Resonance Imaging, and Positron Emission Tomography with Fluorodeoxyglucose Modalities. Semin Ultrasound CT MR 2024:S0887-2171(24)00014-3. [PMID: 38428620 DOI: 10.1053/j.sult.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
This review explores imaging's crucial role in acute Coronavirus Disease 2019 (COVID-19) assessment. High Resolution Computer Tomography is especially effective in detection of lung abnormalities. Chest radiography has limited utility in the initial stages of COVID-19 infection. Lung Ultrasound has emerged as a valuable, radiation-free tool in critical care, and Magnetic Resonance Imaging shows promise as a Computed Tomography alternative. Typical and atypical findings of COVID-19 by each of these modalities are discussed with emphasis on their prognostic value. Considerations for pediatric and immunocompromised cases are outlined. A comprehensive diagnostic approach is recommended, as radiological diagnosis remains challenging in the acute phase.
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Affiliation(s)
- Ian Griffin
- College of Medicine, University of Florida, Gainesville, FL.
| | - Ronak Kundalia
- College of Medicine, University of Florida, Gainesville, FL
| | | | - Joice Prodigios
- Department of Radiology, University of Florida, Gainesville, FL
| | - Nupur Verma
- Department of Radiology, Baystate Medical Center, Springfield, MA
| | - Bruno Hochhegger
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, University of Florida, Gainesville, FL
| | - Tan L Mohammed
- Department of Radiology, New York University, New York, NY
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5
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Mousa A, Blok SG, Karssen D, Aman J, Annema JT, Bogaard HJ, Bonta PI, Haaksma ME, Heldeweg MLA, Lieveld AWE, Nanayakkara P, Nossent EJ, Smit JM, Smit MR, Vlaar APJ, Schultz MJ, Bos LDJ, Paulus F, Tuinman PR. Correlation between Serum Biomarkers and Lung Ultrasound in COVID-19: An Observational Study. Diagnostics (Basel) 2024; 14:421. [PMID: 38396460 PMCID: PMC10888244 DOI: 10.3390/diagnostics14040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Serum biomarkers and lung ultrasound are important measures for prognostication and treatment allocation in patients with COVID-19. Currently, there is a paucity of studies investigating relationships between serum biomarkers and ultrasonographic biomarkers derived from lung ultrasound. This study aims to assess correlations between serum biomarkers and lung ultrasound findings. This study is a secondary analysis of four prospective observational studies in adult patients with COVID-19. Serum biomarkers included markers of epithelial injury, endothelial dysfunction and immune activation. The primary outcome was the correlation between biomarker concentrations and lung ultrasound score assessed with Pearson's (r) or Spearman's (rs) correlations. Forty-four patients (67 [41-88] years old, 25% female, 52% ICU patients) were included. GAS6 (rs = 0.39), CRP (rs = 0.42) and SP-D (rs = 0.36) were correlated with lung ultrasound scores. ANG-1 (rs = -0.39) was inversely correlated with lung ultrasound scores. No correlations were found between lung ultrasound score and several other serum biomarkers. In patients with COVID-19, several serum biomarkers of epithelial injury, endothelial dysfunction and immune activation correlated with lung ultrasound findings. The lack of correlations with certain biomarkers could offer opportunities for precise prognostication and targeted therapeutic interventions by integrating these unlinked biomarkers.
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Affiliation(s)
- Amne Mousa
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (M.L.A.H.)
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com), 1081 HV Amsterdam, The Netherlands
| | - Siebe G. Blok
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com), 1081 HV Amsterdam, The Netherlands
- Department of Intensive Care Medicine, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Dian Karssen
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (M.L.A.H.)
| | - Jurjan Aman
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (E.J.N.)
| | - Jouke T. Annema
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (E.J.N.)
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (E.J.N.)
| | - Peter I. Bonta
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (E.J.N.)
| | - Mark E. Haaksma
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (M.L.A.H.)
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com), 1081 HV Amsterdam, The Netherlands
| | - Micah L. A. Heldeweg
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (M.L.A.H.)
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com), 1081 HV Amsterdam, The Netherlands
| | - Arthur W. E. Lieveld
- Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Prabath Nanayakkara
- Section Acute Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Esther J. Nossent
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (E.J.N.)
| | - Jasper M. Smit
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (M.L.A.H.)
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com), 1081 HV Amsterdam, The Netherlands
| | - Marry R. Smit
- Department of Intensive Care Medicine, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care Medicine, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marcus J. Schultz
- Department of Intensive Care Medicine, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lieuwe D. J. Bos
- Department of Intensive Care Medicine, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Frederique Paulus
- Department of Intensive Care Medicine, Infection and Immunity, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Pieter R. Tuinman
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands (M.L.A.H.)
- Amsterdam Leiden IC Focused Echography (ALIFE, www.alifeofpocus.com), 1081 HV Amsterdam, The Netherlands
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Vetrugno L, Biasucci DG, Deana C, Spadaro S, Lombardi FA, Longhini F, Pisani L, Boero E, Cereser L, Cammarota G, Maggiore SM. Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993-2023). Ultrasound J 2024; 16:7. [PMID: 38345653 PMCID: PMC10861418 DOI: 10.1186/s13089-023-00351-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
In critically ill patients with acute respiratory failure, thoracic images are essential for evaluating the nature, extent and progression of the disease, and for clinical management decisions. For this purpose, computed tomography (CT) is the gold standard. However, transporting patients to the radiology suite and exposure to ionized radiation limit its use. Furthermore, a CT scan is a static diagnostic exam for the thorax, not allowing, for example, appreciation of "lung sliding". Its use is also unsuitable when it is necessary to adapt or decide to modify mechanical ventilation parameters at the bedside in real-time. Therefore, chest X-ray and lung ultrasound are today's contenders for shared second place on the podium to acquire a thoracic image, with their specific strengths and limitations. Finally, electrical impedance tomography (EIT) could soon have a role, however, its assessment is outside the scope of this review. Thus, we aim to carry out the following points: (1) analyze the advancement in knowledge of lung ultrasound use and the related main protocols adopted in intensive care units (ICUs) over the latest 30 years, reporting the principal publications along the way, (2) discuss how and when lung ultrasound should be used in a modern ICU and (3) illustrate the possible future development of LUS.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100, Chieti, Via Dei Vestini, Italy
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care 1, Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Piazzale S. M. Della Misericordia 15, 33100, Udine, Italy.
| | - Savino Spadaro
- Department of Translational Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy
| | | | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Luigi Pisani
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Intensive Care Unit, Miulli Regional Hospital, Acquaviva Delle Fonti, Italy
| | - Enrico Boero
- Anesthesia and Intensive Care Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria Della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Gianmaria Cammarota
- Anesthesia and Intensive Care, Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100, Chieti, Via Dei Vestini, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
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7
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Caroselli C, Blaivas M, Tung Chen Y, Marcosignori M, Cherubini A, Longo D. A Modified Corona Score Using Lung Ultrasound to Identify COVID-19 Patients. Diagnostics (Basel) 2023; 14:51. [PMID: 38201360 PMCID: PMC10804308 DOI: 10.3390/diagnostics14010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND COVID-19 continues to circulate around the world with multiple different strains being active at once. While diagnosis with antigen and molecular testing is more readily available, there is still room for alternative methods of diagnosis, particularly in out-of-hospital settings, e.g., home or nursing homes, and in low-medium income countries, where testing may not be readily available. STUDY OBJECTIVES To evaluate the performance of two modified corona score methods compared with a traditional corona score approach to identify patients with COVID-19. METHODS This was a retrospective multicenter study performed to compare the ability to predict SARS-CoV-2 test results on a nasopharyngeal swab between the corona scores and two novel corona scores (modified 1 corona score (M1CS) and modified 2 corona score (M2CS)). The M1CS included lung ultrasound (LUS) and chest X-ray (CXR) results, while the M2SC only utilized LUS findings without CXRs. Emergency physicians performed point-of-care LUS and a physical examination upon admission to the emergency department. RESULTS Subjects positive for SARS-CoV-2 were older and had higher ferritin levels and temperature and lower diastolic blood pressure and oxygen saturation. The two groups differed on corona score and modified corona scores (p < 0.001 for all). SARS-CoV-2-positive patients had fewer pleural line irregularities (p = 0.025) but presented more frequently with an interstitial pattern on CXRs (p < 0.001). CONCLUSIONS In our study, LUS alone provided a valuable contribution to the corona score and improved its performance more than when CXR results were included. These results suggest that resource-limited areas where CXRs may be unavailable or prohibitively expensive can utilize an ultrasound as the sole imaging modality without a loss of diagnostic performance for SARS-CoV-2 pneumonia diagnosis.
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Affiliation(s)
- Costantino Caroselli
- Acute Geriatric Unit, Geriatric Emergency Room and Aging Research Centre IRCCS INRCA, 60127 Ancona, Italy;
| | - Michael Blaivas
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, SC 29209, USA;
| | - Yale Tung Chen
- Internal Medicine Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - Matteo Marcosignori
- Emergency Department, Azienda Ospedaliero Universitaria, Ospedali Riuniti, 60123 Ancona, Italy;
| | - Antonio Cherubini
- Acute Geriatric Unit, Geriatric Emergency Room and Aging Research Centre IRCCS INRCA, 60127 Ancona, Italy;
| | - Daniele Longo
- Department of Prevention, APSS, 38123 Trento, Italy;
- Department of Diagnostics and Public Health, School of Medicine and Surgery, Università di Verona, 37124 Verona, Italy
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8
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Sultan LR, Haertter A, Al-Hasani M, Demiris G, Cary TW, Tung-Chen Y, Sehgal CM. Can Artificial Intelligence Aid Diagnosis by Teleguided Point-of-Care Ultrasound? A Pilot Study for Evaluating a Novel Computer Algorithm for COVID-19 Diagnosis Using Lung Ultrasound. AI 2023; 4:875-887. [PMID: 37929255 PMCID: PMC10623579 DOI: 10.3390/ai4040044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
With the 2019 coronavirus disease (COVID-19) pandemic, there is an increasing demand for remote monitoring technologies to reduce patient and provider exposure. One field that has an increasing potential is teleguided ultrasound, where telemedicine and point-of-care ultrasound (POCUS) merge to create this new scope. Teleguided POCUS can minimize staff exposure while preserving patient safety and oversight during bedside procedures. In this paper, we propose the use of teleguided POCUS supported by AI technologies for the remote monitoring of COVID-19 patients by non-experienced personnel including self-monitoring by the patients themselves. Our hypothesis is that AI technologies can facilitate the remote monitoring of COVID-19 patients through the utilization of POCUS devices, even when operated by individuals without formal medical training. In pursuit of this goal, we performed a pilot analysis to evaluate the performance of users with different clinical backgrounds using a computer-based system for COVID-19 detection using lung ultrasound. The purpose of the analysis was to emphasize the potential of the proposed AI technology for improving diagnostic performance, especially for users with less experience.
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Affiliation(s)
- Laith R. Sultan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Allison Haertter
- Radiation Oncology Department, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maryam Al-Hasani
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - George Demiris
- Informatics Division of the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore W. Cary
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
| | - Yale Tung-Chen
- Emergency Medicine Department, La Madrida Hospital, 28006 Madrid, Spain
| | - Chandra M. Sehgal
- Ultrasound Research Lab, Department of Radiology, University of Pennsylvania, Philadelphia, PA 19103, USA
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Clofent D, Culebras M, Felipe-Montiel A, Arjona-Peris M, Granados G, Sáez M, Pilia F, Ferreiro A, Álvarez A, Loor K, Bosch-Nicolau P, Polverino E. Serial lung ultrasound in monitoring viral pneumonia: the lesson learned from COVID-19. ERJ Open Res 2023; 9:00017-2023. [PMID: 37583967 PMCID: PMC10423983 DOI: 10.1183/23120541.00017-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/15/2023] [Indexed: 08/17/2023] Open
Abstract
Background Lung ultrasound (LUS) has proven to be useful in the evaluation of lung involvement in COVID-19. However, its effectiveness for predicting the risk of severe disease is still up for debate. The aim of the study was to establish the prognostic accuracy of serial LUS examinations in the prediction of clinical deterioration in hospitalised patients with COVID-19. Methods Prospective single-centre cohort study of patients hospitalised for COVID-19. The study protocol consisted of a LUS examination within 24 h from admission and a follow-up examination on day 3 of hospitalisation. Lung involvement was evaluated by a 14-area LUS score. The primary end-point was the ability of LUS to predict clinical deterioration defined as need for intensive respiratory support with high-flow oxygen or invasive mechanical ventilation. Results 200 patients were included and 35 (17.5%) of them reached the primary end-point and were transferred to the intensive care unit (ICU). The LUS score at admission had been significantly higher in the ICU group than in the non-ICU group (22 (interquartile range (IQR) 20-26) versus 12 (IQR 8-15)). A LUS score at admission ≥17 was shown to be the best cut-off point to discriminate patients at risk of deterioration (area under the curve (AUC) 0.95). The absence of progression in LUS score on day 3 significantly increased the prediction accuracy by ruling out deterioration with a negative predictive value of 99.29%. Conclusion Serial LUS is a reliable tool in predicting the risk of respiratory deterioration in patients hospitalised due to COVID-19 pneumonia. LUS could be further implemented in the future for risk stratification of viral pneumonia.
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Affiliation(s)
- David Clofent
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Mario Culebras
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Almudena Felipe-Montiel
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Marta Arjona-Peris
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Galo Granados
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - María Sáez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Florencia Pilia
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Antía Ferreiro
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Álvarez
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- CIBER Enfermedades Respiratorias, Barcelona, Spain
| | - Karina Loor
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Pau Bosch-Nicolau
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eva Polverino
- Department of Respiratory Medicine, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Institut de Recerca, Barcelona, Spain
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Rocca E, Zanza C, Longhitano Y, Piccolella F, Romenskaya T, Racca F, Savioli G, Saviano A, Piccioni A, Mongodi S. Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review. Adv Respir Med 2023; 91:203-223. [PMID: 37218800 DOI: 10.3390/arm91030017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
Lung ultrasound has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures; among point-of-care ultrasound techniques, the lung ultrasound saw the greatest spread in the last decade. The COVID-19 pandemic has given a boost to the use of ultrasound since it allows to obtain a wide range of clinical information with a bedside, not harmful, repeatable examination that is reliable. This led to the remarkable growth of publications on lung ultrasounds. The first part of this narrative review aims to discuss basic aspects of lung ultrasounds, from the machine setting, probe choice, and standard examination to signs and semiotics for qualitative and quantitative lung ultrasound interpretation. The second part focuses on how to use lung ultrasound to answer specific clinical questions in critical care units and in emergency departments.
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Affiliation(s)
- Eduardo Rocca
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Christian Zanza
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Fabio Piccolella
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Tatsiana Romenskaya
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care Medicine, AON SS. Antonio e Biagio e Cesare Arrigo H, 15121 Alessandria, Italy
- Department of Anesthesia and Critical Care Medicine, AO Mauriziano Hospital, University of Turin, 10124 Turin, Italy
| | - Gabriele Savioli
- Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Angela Saviano
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
| | - Silvia Mongodi
- Department of Anesthesia and Intensive Care Medicine, Critical Care Unit-1, Fondazione IRCCS Policlinico S. Matteo, 27100 Pavia, Italy
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11
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Buonsenso D, Morello R, Mariani F, De Rose C, Cortese R, Vetrugno L, Valentini P. Role of Lung Ultrasound in the Follow-Up of Children with Previous SARS-CoV-2 Infection: A Case-Control Assessment of Children with Long COVID or Fully Recovered. J Clin Med 2023; 12:jcm12093342. [PMID: 37176782 PMCID: PMC10179159 DOI: 10.3390/jcm12093342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Lung ultrasound (LUS) can detect lower respiratory tract involvement in children with acute SARS-CoV-2 infection. However, its role in follow-up assessments is still unclear. To describe LUS findings in children after SARS-CoV-2 infection, we conducted a prospective study in a population of pediatric patients referred to the post-COVID unit in a tertiary center during the study period from February 2021 to May 2022. Children were classified as recovered from acute infection or with persisting symptoms. LUS was performed in all children and a LUS score (ranging from 0 to 36 points) was calculated according to the Italian Academy of Thoracic Ultrasound. Six hundred forty-seven children (304 females, 47%) were enrolled. The median follow-up evaluation was two months. The median age was 7.9 (IQR: 6) years. At the follow-up evaluation, 251 patients (38.8%) had persistent symptoms, of whom 104 (16.1%) had at least one respiratory symptom. The median LUS level was 2 (IQR: 4). LUS findings and LUS scores did not differ in children with Long COVID compared to the group of children fully recovered from the initial infection. In conclusion, after SARS-CoV-2 infection, LUS was mostly normal or showed minimal artifacts in all groups of children.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Global Health Center, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Rossella Cortese
- School of Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Patel K, Rashid A, Spear L, Gholamrezanezhad A. A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations. Life (Basel) 2023; 13:life13040962. [PMID: 37109491 PMCID: PMC10146527 DOI: 10.3390/life13040962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic ushered in rapid changes in healthcare, including radiology, globally. This review discusses the impact of the pandemic on various radiology departments globally. We analyze the implications of the COVID-19 pandemic on the imaging volumes, finances, and clinical operations of radiology departments in 2020. Studies from health systems and outpatient imaging centers were analyzed, and the activity throughout 2020 was compared to the pre-pandemic activity, including activity during similar timeframes in 2019. Imaging volumes across modalities, including MRI and CT scans, were compared, as were the Relative Value Units (RVUs) for imaging finances. Furthermore, we compared clinical operations, including staffing and sanitation procedures. We found that imaging volumes in private practices and academic centers decreased globally. The decreases in volume could be attributed to delayed patient screenings, as well as the implementation of protocols, such as the deep cleaning of equipment between patients. Revenues from imaging also decreased globally, with many institutions noting a substantial decline in RVUs and revenue compared with pre-COVID-19 levels. Our analysis thus found significant changes in the volumes, finances, and operations of radiology departments due to the COVID-19 pandemic.
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Affiliation(s)
- Kishan Patel
- Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arnav Rashid
- Department of Biological Sciences, Dana and David Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Luke Spear
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
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