Irene W Y Ma1,2, Arif Hussain3, Michael Wagner4, Brandie Walker5, Alex Chee6, Shane Arishenkoff7, Brian Buchanan8, Rachel B Liu9, Gregory Mints10, Tanping Wong10, Vicki Noble11, Ana Claudia Tonelli12, Elaine Dumoulin5, Daniel J Miller5, Christopher A Hergott5, Andrew S Liteplo2. 1. Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 2. Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 3. Division of Cardiac Critical Care, Department of Cardiac Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 4. Division of Hospital Medicine, Department of Medicine, Prisma Health-Upstate, Greenville, South Carolina, USA. 5. Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 6. Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. 7. Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 8. Department of Critical Care, University of Alberta, Edmonton, Alberta, Canada. 9. Section of Emergency Ultrasound, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA. 10. Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York, USA. 11. Department of Emergency Medicine, University Hospitals, Cleveland Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio, USA. 12. Department of General Internal Medicine, Hospital de Clinicas de Porto Alegre and Department of Medicine, Unisinos University, São Leopoldo, Brazil.
Abstract
OBJECTIVES: To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID-19). METHODS: Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered. RESULTS: Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus. CONCLUSIONS: In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.
OBJECTIVES: To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID-19). METHODS: Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered. RESULTS: Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus. CONCLUSIONS: In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.
Authors: Andrew J Goldsmith; Ahad Al Saud; Nicole M Duggan; Irene W Ma; Calvin K Huang; Onyinyechi Eke; Tina Kapur; Sigmund Kharasch; Andrew Liteplo; Hamid Shokoohi Journal: Cureus Date: 2022-01-11
Authors: Kristin Flemons; Barry Baylis; Aurang Zeb Khan; Andrew W Kirkpatrick; Ken Whitehead; Shahab Moeini; Allister Schreiber; Stephanie Lapointe; Sara Ashoori; Mishal Arif; Byron Berenger; John Conly; Wade Hawkins Journal: Am J Infect Control Date: 2022-08 Impact factor: 4.303