OBJECTIVE:Bedside chest ultrasonography, when integrated with clinical data, is an accurate tool for improving the diagnostic process of many respiratory diseases. This study aims to evaluate the feasibility of a chest ultrasonographic screening program in nursing homes for detecting coronavirus disease-19 (COVID-19)-related pneumonia and improving the appropriateness of hospital referral of residents. DESIGN:Pragmatic, descriptive, feasibility study from April 2 to April 9, 2020. SETTING AND PARTICIPANTS:A total of 83 older residents (age 85 ± 8) presenting mild to moderate respiratory symptoms and not previously tested for COVID-19, residing in 5 nursing homes in Northern Italy. METHODS:Chest ultrasonography was performed at the bedside by a team of hospital specialists with certified expertise in thoracic ultrasonography, following a systematic approach exploring 4 different areas for each hemithorax, from the anterior and posterior side. Presence of ultrasonographic signs of interstitial pneumonia, including comet-tail artifacts (B-lines) with focal or diffuse distribution, subpleural consolidations, and pleural line indentation, was detected. The specialist team integrated ultrasonography data with clinical and anamnestic information, and gave personalized therapeutic advice for each patient, including hospital referral when needed. RESULTS:The most frequent reasons for ultrasonographic evaluation were fever (63% of participants) and mild dyspnea (40%). Fifty-six patients (67%) had abnormal ultrasonographic findings. The most common patterns were presence of multiple subpleural consolidations (32 patients) and diffuse B-lines (24 patients), with bilateral involvement. A diagnosis of suspect COVID-19 pneumonia was made in 44 patients, and 6 of them required hospitalization. Twelve patients had ultrasonographic patterns suggesting other respiratory diseases, and 2 patients with normal ultrasonographic findings were diagnosed with COPD exacerbation. CONCLUSIONS AND IMPLICATIONS:In nursing home residents, screening of COVID-19 pneumonia with bedside chest ultrasonography is feasible and may represent a valid diagnostic aid for an early detection of COVID-19 outbreaks and adequate patient management.

译文

目的:床旁胸部超声检查与临床数据相结合,是改善许多呼吸系统疾病诊断过程的准确工具。这项研究的目的是评估在护理院中进行胸部超声检查程序以检测冠状病毒病19(COVID-19)相关性肺炎并提高住院病人转诊的适宜性的可行性。
设计:2020年4月2日至4月9日的实用,描述性,可行性研究。
地点和参加者:居住在意大利北部的5家疗养院中,共有83名年龄稍大的居民(年龄85±8),表现出轻度至中度的呼吸道症状,以前没有接受过COVID-19的测试。
方法:由一组经胸腔超声检查合格的专业医生在床旁进行胸部超声检查,采用系统的方法,从前侧和后侧针对每个半胸腔探查4个不同区域。检测到间质性肺炎的超声征象,包括具有局灶性或弥散性分布的彗尾伪影(B线),胸膜下巩固和胸膜线压痕。专家团队将超声检查数据与临床和记忆检查信息集成在一起,并为每位患者提供个性化的治疗建议,包括在需要时转诊医院。
结果:超声检查最常见的原因是发烧(占参与者的63%)和轻度呼吸困难(占40%)。五十六例患者(67%)超声检查结果异常。最常见的模式是多发性胸膜下巩固(32例)和弥漫性B线(24例),双侧受累。诊断为疑似COVID-19肺炎的44例患者,其中6例需要住院治疗。 12例患者的超声检查提示有其他呼吸系统疾病,其中2例超声检查结果正常的患者被诊断为COPD恶化。
结论和意义:在疗养院居民中,通过床旁胸部超声检查筛查COVID-19肺炎是可行的,并且可能是早期发现COVID-19暴发和适当患者管理的有效诊断手段。

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