Combining lung ultrasound and Wells score for diagnosing pulmonary embolism in critically ill COVID-19 patients.
Aged
COVID-19
/ complications
Clinical Decision Rules
Computed Tomography Angiography
Critical Illness
Female
Humans
Lung
/ diagnostic imaging
Male
Middle Aged
Multimodal Imaging
Predictive Value of Tests
Pulmonary Artery
/ diagnostic imaging
Pulmonary Embolism
/ diagnostic imaging
Registries
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Ultrasonography
COVID-19
CTPA
Lung ultrasound
Pulmonary embolism
SARS-CoV2
Wells score
Journal
Journal of thrombosis and thrombolysis
ISSN: 1573-742X
Titre abrégé: J Thromb Thrombolysis
Pays: Netherlands
ID NLM: 9502018
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
accepted:
24
10
2020
pubmed:
5
11
2020
medline:
22
7
2021
entrez:
4
11
2020
Statut:
ppublish
Résumé
Subpleural consolidations have been found in lung ultrasound in patients with COVID-19, possibly deriving from pulmonary embolism (PE). The diagnostic utility of impact of lung ultrasound in critical-ill patients with COVID-19 for PE diagnostics however is unclear. We retrospectively evaluated all SARS-CoV2-associated ARDS patients admitted to our ICU between March 8th and May 31th 2020. They were enrolled in this study, when a lung ultrasound and a computed tomography pulmonary angiography (CTPA) were documented. In addition, wells score was calculated to estimate the probability of PE. The CTPA was used as the gold standard for the detection of PE. Twenty out of 25 patients met the inclusion criteria. In 12/20 patients (60%) (sub-) segmental PE were detected by CT-angiography. Lung ultrasound found subpleural consolidations in 90% of patients. PE-typical large supleural consolidations with a size ≥ 1 cm were detectable in 65% of patients and were significant more frequent in patients with PE compared to those without (p = 0.035). Large consolidations predicted PE with a sensitivity of 77% and a specificity of 71%. The Wells score was significantly higher in patients with PE compared to those without (2.7 ± 0.8 and 1.7 ± 0.5, respectively, p = 0.042) and predicted PE with an AUC of 0.81. When combining the two modalities, comparing patients with considered/probable PE using LUS plus a Wells score ≥ 2 to patients with possible/unlikely PE in LUS plus a Wells score < 2, PE could be predicted with a sensitivity of 100% and a specificity of 80%. Large consolidations detected in lung ultrasound were found frequently in COVID-19 ARDS patients with pulmonary embolism. In combination with a Wells score > 2, this might indicate a high-risk for PE in COVID-19.
Identifiants
pubmed: 33145663
doi: 10.1007/s11239-020-02323-0
pii: 10.1007/s11239-020-02323-0
pmc: PMC7608377
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
76-84Informations de copyright
© 2020. The Author(s).
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