75 Reliability of Nurse-Perfromed Lung Ultrasonography of Suspected COVID-19 Patients at the Emergency Department Traige a Single-Center Study

Babasa, R. B.; Evangelista-Gonzales, R. W.

Study Objectives: Point-of-care lung ultrasound is now considered a valuable tool in the emergency department (ED) to evaluate patients with respiratory complaints. It is very reliable in detecting artifacts associated with alveolar-interstitial syndrome - a common feature seen in patients with pneumonia, pulmonary edema and more recently, COVID-19. The aim of this study was to determine the reliability of ED nurses to interpret point-of-care lung ultrasound artifacts suggestive of COVID-19 respiratory disease at the triage. Methods: Our single-center study prospectively evaluated all consecutive patients who were suspected of COVID-19 respiratory disease at the ED of St. Luke’s Medical Center-Quezon City. Eligible patients underwent lung ultrasonography conducted by a trained ED nurse. The ultrasound scans were recorded, stored and interpreted by nurses as to the presence or absence of B- lines, C- lines and/or pleural effusion. These scans were then subsequently viewed and interpreted by an emergency medicine (EM) physician and then finally by a senior ED consultant who is an expert on point-of-care ultrasound (POCUS). Results: A total of 382 patients were included in the study, which generated 3057 lung ultrasound scans for analysis. Nurse agreement in interpreting B-lines with the emergency physician and the POCUS expert were satisfactory yielding Cohen’s Kappa score of 0.845 (excellent agreement) and 0.781 (good agreement) respectively. On the other hand, nurse agreement in interpreting C-lines with the emergency physician and the POCUS expert were acceptable at a Kappa of 0.678 (good agreement) and 0.272 (fair agreement), respectively. Conclusion: Our results suggest that nurses who have been trained in the use of point-of-care lung ultrasound can reliably identify and interpret ultrasound artifacts most notably B- lines. In light of the ongoing COVID-19 pandemic, nurse-performed lung ultrasonography can potentially provide a useful and expedient triage strategy for suspected SARS-CoV-2 patients presenting at the ED.