Lung Ultrasound Better Than Chest X-Ray for Diagnosis of COVID-19, Finds Study

A new study has found that portable ultrasound scans are more sensitive than X-rays for the preliminary detection of atypical pneumonia in patients who may have COVID-19.

Physicians have been trying to figure out the best approach to initial imaging in patients who may have COVID-19. In a presentation at the virtual American College of Emergency Physicians meeting, Ryan C. Gibbons, MD, of the Lewis Katz School of Medicine at Temple University (Philadelphia, PA, USA) reported findings from a study of possible COVID-19 patients who presented to the emergency department (ED). Gibbons and his team prospectively tracked 143 consecutive potential COVID-19 patients who presented at the ED. Each patient was screened via handheld ultrasound and portable X-ray. Those at high-risk, and those who showed abnormal findings, were sent for CT scans.

The physicians interpreted 99 ultrasound scans and 73 X-rays as positive. The CT scans confirmed that 75% (95% CI 66.0-83.2) of these patients had atypical pneumonia. This number was especially high because the patients were tracked during a period of widespread infection, according to Gibbons. They found the specificity to be 33.3% (95% CI 16.5-54.0) for ultrasound and 44.4% (95% CI 25.5-64.7) for X-ray. The study found that ultrasound had a sensitivity of 97.6% (95% CI 91.6-99.7) as compared to 69.9% (95% CI 58.8-79.5) for X-ray.

Based on these findings, Gibbons has urged an "ultrasound first" approach to screening. "It's a valuable tool to quickly separate the lower-risk from higher-risk patients and move those lower-risk patients out," he told MedPage Today following his online presentation. Ultrasound scans, which can easily be performed at bedside with handheld devices, are also more convenient than X-rays, according to Gibbons. Physicians use "a handheld probe that plugs into an iPad. You can be in and out of a room in under a few minutes and sanitization is very quick. And we're not transporting a patient to and from X-ray or having to wait for a portable X-ray machine," he said.

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