TY - JOUR
T1 - Multi-organ point-of-care ultrasound for detection of pulmonary embolism in critically ill COVID-19 patients - A diagnostic accuracy study
AU - Lieveld, Arthur
AU - Heldeweg, M L A
AU - Smit, J M
AU - Haaksma, M E
AU - Veldhuis, L
AU - Walburgh-Schmidt, R S
AU - Twisk, J
AU - Nanayakkara, P W B
AU - Heunks, L
AU - Tuinman, P R
N1 - Publisher Copyright: © 2022 The Author(s)
PY - 2022/6/1
Y1 - 2022/6/1
N2 - PURPOSE: Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis.MATERIALS & METHODS: This prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination.RESULTS: 70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7]).CONCLUSIONS: Multi-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA.REGISTRATION: www.trialregister.nl: NL8540.
AB - PURPOSE: Critically ill COVID-19 patients have an increased risk of developing pulmonary embolism (PE). Diagnosis of PE by point-of-care ultrasound (POCUS) might reduce the need for computed tomography pulmonary angiography (CTPA), while decreasing time-to-diagnosis.MATERIALS & METHODS: This prospective, observational study included adult ICU patients with COVID-19. Multi-organ (lungs, deep vein, cardiac) POCUS was performed within 24 h of CTPA, looking for subpleural consolidations, deep venous thrombosis (DVT), and right ventricular strain (RVS). We reported the scan time, and calculated diagnostic accuracy measures for these signs separately and in combination.RESULTS: 70 consecutive patients were included. 23 patients (32.8%) had a PE. Median scan time was 14 min (IQR 11-17). Subpleural consolidations' diagnostic accuracy was: 42.9% (95%CI [34.1-52.0]). DVT's and RVS' diagnostic accuracy was: 75.6% (95%CI [67.1-82.9]) and 74.4% (95%CI [65.8-81.8]). Their sensitivity was: 24.0% (95%CI [9.4-45.1]), and 40.0% (95%CI [21.3-61.3]), while their specificity was: 88.8% (95%CI [80.8-94.3]), and: 83.0% (95%CI [74.2-89.8]), respectively. Multi-organ POCUS sensitivity was: 87.5% (95%CI [67.6-97.3]), and specificity was: 25% (95%CI [16.9-34.7]).CONCLUSIONS: Multi-organ rather than single-organ POCUS can be of aid in ruling out PE in critically ill COVID-19 and help select patients for CTPA. In addition, finding RVS can make PE more likely, while a DVT would preclude the need for a CTPA.REGISTRATION: www.trialregister.nl: NL8540.
KW - COVID-19
KW - Diagnostics
KW - ICU
KW - POCUS
KW - Point-of-care ultrasound
KW - Pulmonary embolism
UR - http://www.scopus.com/inward/record.url?scp=85123703463&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2022.153992
DO - https://doi.org/10.1016/j.jcrc.2022.153992
M3 - Article
C2 - 35104693
SN - 0883-9441
VL - 69
SP - 153992
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 153992
ER -