Lung Ultrasound findings are associated with mortality and need of intensive care admission in COVID-19 patients evaluated in the Emergency Department

Bonadia, Nicola; Carnicelli, Annamaria; Piano, Alfonso; Buonsenso, Danilo; Gilardi, Emanuele; Kadhim, Cristina; Torelli, Enrico; Petrucci, Martina; Di Maurizio, Luca; Biasucci, Daniele Guerino; Fuorlo, Mariella; Forte, Evelina; Zaccaria, Raffaella; Franceschi, Francesco

Lung Ultrasound (LUS) has been recently advocated as an accurate tool to diagnose COVID-19 pneumonia. However, reports on its use are mainly based on hypotheses studies, case reports or small retrospective case series, while the prognostic role of LUS in COVID-19 patients has not yet been established. We conducted a prospective study aiming to assess the ability of LUS in predicting mortality and intensive care unit admission of COVID-19 patients evaluated in a tertiary level emergency department. Patients in our sample had a median of 6 lung areas with pathological findings (IQR 6, range 0-14), defined as a score different from 0. The median rate of lung areas involved was 71% (IQR 64%, range 0-100) while the median average score was 1.14 (IQR 0.93, range 0-3). A higher rate of pathological lung areas and of average score was significantly associated with death with estimated difference of 40.5% (95% CI 4-68%, p 0.01) and of 0.47 (95% CI 0.06 – 0.93, p 0.02), respectively. Similarly, the same parameters were associated with a significantly higher risk of intensive care unit admission with ad estimated difference of 29% (95% CI 8-50%, p 0.008) and of 0.47 (95% CI 0.05-0.93, p 0.02), respectively. Our study shows that LUS is able to detect COVID-19 pneumonia and to predict, during the first evaluation in the emergency department, patients at risk of intensive care unit admission and death.