The Role of Lung Ultrasound for Detection of COVID-19 in Emergency Departments:Systematic Review and Meta-Analysis

Abstract

The point of care ultrasound (POCUS) recently has been used to evaluate COVID-19 patients in emergency departments. However, there is no systematic review and meta-analysis synthesised the published evidence to determine the diagnostic performance of lung ultrasound (LUS). The hypothesis was that LUS can accurately diagnose COVID-19 patients presenting to emergency departments compared to real-time polymerase chain reaction (RT-PCR) as a reference test. Hence, the objective was to systematically review the published literature investigating the use of LUS on COVID-19 in emergency settings. Additionally, compare the diagnostic performance of LUS against lung computed tomography (LCT). The search done on MEDLINE, Embase, Web of Science, and PubMed databases for eligible studies that met the inclusion criteria. The QUADAS-2 tool was used to appraise the included studies’ quality. The LUS and LCT pooled diagnostic performance were measured using DerSimonian–Laird random effect method. Sixteen studies met the eligibility criteria and were included on the study. The pooled sensitivity, specificity and area under curve (AUC) were 86.9%, 62.4% and 71% respectively for LUS and 93.5%, 72.6% and 93% respectively LCT. The LUS has a moderate overall diagnostic performance with particularly poor specificity. Therefore, it should not be used alone as a diagnostic tool in the emergency department. The LCT diagnostic performance is slightly higher than LUS, as LUS features are not specific for COVID-19. The LUS demonstrated acceptable sensitivity but poor specificity when used independently to diagnose COVID-19 patients in emergency department.