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Portable Lung Ultrasound more sensitive, less specific than portable Chest Xray in COVID-19 pneumonia: ACEP presentation

2020-11-01
sars-cov-2 virions by EM: NIAID

A presentation at the American College of Emergency Physicians (ACEP) virtual meeting showed that portable ultrasound examination of the lungs in patients presenting with suspected COVID-19 pneumonia is much more sensitive (although less specific) than portable chest X-ray. If the ultrasound exam is abnormal, a chest CT scan should be performed at once. The presentation was summarized on Medpage Today for November 1, 2020.

From the summary:

In a study of possible COVID-19 patients who presented to the emergency department (ED), ultrasound sensitivity was 97.6% (95% CI 91.6-99.7) versus 69.9% (95% CI 58.8-79.5) for x-ray, reported Ryan C. Gibbons, MD, of the Lewis Katz School of Medicine at Temple University in Philadelphia, in a presentation at the virtual American College of Emergency Physicians meeting.

Gibbons and colleagues prospectively tracked 143 consecutive potential COVID-19 patients who presented at an 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.

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. Gibbons said this number is especially high because the patients were tracked during a period of widespread infection.

Specificity was 33.3% (95% CI 16.5-54.0) for ultrasound and 44.4% (95% CI 25.5-64.7) for x-ray.

https://www.medpagetoday.com/meetingcoverage/acep/89433

Based on these findings, the recommended protocol is to proceed directly to CT (computed tomography) scanning when the ultrasound is abnormal. This leads to the best performance and avoids wasting time and energy on portable chest X-rays.

This was, in fact, the procedure followed when the president was hospitalized with COVID-19 in early October. Those not familiar with this technique may have been puzzled by the mention of ultrasounds where past practice would have been a portable chest X-ray. This is one of the innovations that have resulted from experience in the emergency room with the novel coronavirus.

The general public was not advised of the results found when the president was evaluated, and there was no mention of CT scanning. Based on prior behavior with this president, we can assume that the ultrasound was abnormal and that the CT scan confirmed the presence of pneumonia.

The assumption that our current president had COVID pneumonia and was only hospitalized for three days fits with our expectations. We expect that everything about this administration is abnormal and unsafe. A normal president would have spent a week in the hospital under observation and would not have gone for a joy-ride in his hermetically-sealed limousine for the entertainment of his fans.

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