Sensitivity of Lung Point-of-Care Ultrasound (POCUS) to Predict Oxygen Requirements in Emerging Viral Infections.

IF 2.1 4区医学 Q2 ACOUSTICS

Journal of Ultrasound in Medicine Pub Date : 2025-01-21 DOI:10.1002/jum.16647

Daniel L Theodoro, Di Coneybeare, Penelope Lema, Nicholas Renz, Laura Wallace, Enyo Ablordeppey, Sean Stickles, Alek Rosenthal, Ian Holley, Sirivalli Chamarti, Josie Acuña, James Patterson, Rachel Ancona, Srikar Adhikari

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引用次数: 0

Abstract

Objectives: The prognostic characteristics of lung point-of-care ultrasound (L-POCUS) to predict respiratory decompensation in patients with emerging infections remains unstudied. Our objective was to examine whether scored lung ultrasounds predict hypoxia among a nonhypoxic, ambulatory population of patients with COVID-19.

Methods: This was a diagnostic case-control study. Three academic emergency departments across the United States collected a convenience sample of nonhypoxic subjects with COVID-19, scored subjects' hemithorax at 7 locations using lung ultrasound, and followed outcomes for 40 days. We defined cases as hypoxia (≤91% by pulse oxygenation) from 2 hours after index presentation to day 40. Follow-up was by telephone plus home pulse oximeter and by chart review. We conducted a logistic regression to test the association between L-POCUS scores and hypoxia. To evaluate lung ultrasound score prediction of a hypoxic event, we calculated sensitivity and specificity at optimal cut off scores and report receiver operating characteristic curve and area under the curve.

Results: We enrolled 163 subjects but excluded 15 (3 duplicate entries; 12 lost to follow up). Median age was 41 years (interquartile range [IQR] 31-56); 83 (56%) were female, and median body mass index was 29 (IQR 25-35). We classified 47 of 148 as hypoxic cases (32%, 95% confidence interval [CI]: 25-40), leaving 101 controls. L-POCUS scores associated with hypoxia by logistic regression (odds ratio = 1.05, 95% CI: 1.02-1.08), with a 5% increase in odds of hypoxia for each 1-unit increase in L-POCUS score. The optimal cut-off score was 15 (sensitivity, 0.60; specificity, 0.73) and the area under the curve was 0·66 (95% CI 0·58-0·75). The correctly classified proportion was 69% (95% CI: 61-76).

Conclusions: Among nonhypoxic COVID-19 patients, higher L-POCUS rubric scores were associated with hypoxia but no scoring threshold strongly predicts hypoxia at 40 days.

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肺部即时超声（POCUS）预测新发病毒感染需氧量的敏感性

目的：肺点超声（L-POCUS）预测新发感染患者呼吸失代偿的预后特征仍未研究。我们的目的是研究肺部超声评分是否能预测非缺氧的COVID-19患者流动人群中的缺氧情况。方法：诊断性病例-对照研究。美国三家学术急诊科收集了COVID-19非缺氧患者的方便样本，使用肺超声在7个位置对受试者的半胸进行评分，并随访40天。我们将病例定义为在指标出现后2小时至第40天缺氧（脉搏氧合≤91%）。随访是通过电话加家庭脉搏血氧仪和图表检查。我们进行了逻辑回归来检验L-POCUS评分与缺氧之间的关系。为了评估肺超声评分对缺氧事件的预测，我们计算了最佳临界值的敏感性和特异性，并报告了受试者工作特征曲线和曲线下面积。结果：我们纳入了163名受试者，但排除了15名(3个重复条目；12 .失去了跟进)。中位年龄41岁（四分位数范围[IQR] 31-56）；女性83例（56%），中位体重指数为29 （IQR 25-35）。我们将148例中的47例归为缺氧病例（32%，95%置信区间[CI]: 25-40），剩下101例作为对照。经logistic回归分析，L-POCUS评分与缺氧相关（优势比= 1.05,95% CI: 1.02-1.08）， L-POCUS评分每增加1个单位，缺氧的几率增加5%。最佳分值为15分(敏感性0.60；特异性为0.73)，曲线下面积为0.66 （95% CI为0.58 ~ 0.75）。正确分类比例为69% （95% CI: 61-76）。结论：在非缺氧的COVID-19患者中，较高的L-POCUS评分与缺氧相关，但没有评分阈值强烈预测40天的缺氧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Ultrasound in Medicine 医学-核医学

CiteScore

5.10

自引率

4.30%

发文量

205

审稿时长

1.5 months

期刊介绍： The Journal of Ultrasound in Medicine (JUM) is dedicated to the rapid, accurate publication of original articles dealing with all aspects of medical ultrasound, particularly its direct application to patient care but also relevant basic science, advances in instrumentation, and biological effects. The journal is an official publication of the American Institute of Ultrasound in Medicine and publishes articles in a variety of categories, including Original Research papers, Review Articles, Pictorial Essays, Technical Innovations, Case Series, Letters to the Editor, and more, from an international bevy of countries in a continual effort to showcase and promote advances in the ultrasound community. Represented through these efforts are a wide variety of disciplines of ultrasound, including, but not limited to: -Basic Science- Breast Ultrasound- Contrast-Enhanced Ultrasound- Dermatology- Echocardiography- Elastography- Emergency Medicine- Fetal Echocardiography- Gastrointestinal Ultrasound- General and Abdominal Ultrasound- Genitourinary Ultrasound- Gynecologic Ultrasound- Head and Neck Ultrasound- High Frequency Clinical and Preclinical Imaging- Interventional-Intraoperative Ultrasound- Musculoskeletal Ultrasound- Neurosonology- Obstetric Ultrasound- Ophthalmologic Ultrasound- Pediatric Ultrasound- Point-of-Care Ultrasound- Public Policy- Superficial Structures- Therapeutic Ultrasound- Ultrasound Education- Ultrasound in Global Health- Urologic Ultrasound- Vascular Ultrasound