Hard-pressed emergency room physicians in the places where the COVID-19 epidemic struck the hardest—such as Italy and Spain—needed a way to quickly determine whether patients with seemingly mild illnesses might have some more serious lung involvement. Many started reaching toward the closest ultrasound probes. Now a team of Italian physicians has developed a formal protocol for this use of ultrasound as a diagnostic tool, published in the Journal of Ultrasound Medicine and reported on in MedScape.
Their research, which builds on previous work by the team, offers broad agreement with industry-led algorithms and emphasizes the use of wireless, handheld ultrasound devices, ideally consisting of a separate probe and tablet, to make sterilization easy.
In developing and publishing their protocol, [Libertario Demi, PhD, head of the ultrasound laboratory, University of Trento, Italy], senior author of the article, and other colleagues from the heavily affected cities of Northern Italy, say their aim is “to share our experience and to propose a standardization with respect to the use of lung ultrasound in the management of COVID-19 patients.”
However, lung ultrasound is not yet universally accepted as a tool for diagnosing pneumonia in the context of COVID-19 and triaging patients.
The National Health Service in England does not even mention lung ultrasound in its radiology decision tool for suspected COVID-19, specifying instead chest X-ray as the first-line diagnostic imaging tool, with CT scanning in equivocal cases.
But Giovanni Volpicelli, MD, University Hospital San Luigi Gonzaga, Turin, Italy, says many patients with COVID-19 in his hospital presented with a negative chest X-ray but were found to have interstitial pneumonia on lung ultrasound.
Moreover, while CT scan remains the gold standard, the risk of nosocomial infection is more easily controlled if patients do not have to be transported to the radiology department but remain in the emergency room and instead undergo lung ultrasound there, he stressed.