LUNG ULTRASOUND IN RULING OUT COVID-19 AMONG HEALTHCARE WORKERS IN TWO
ITALIAN EMERGENCY DEPARTMENTS: A MULTICENTER STUDY.
Abstract
Purpose: The high percentage of asymptomatic patients and the non-high
sensitivity of real-time reverse transcription-polymerase chain reaction
(RT-PCR) test on nasopharyngeal swab cause some healthcare workers to be
infected but asymptomatic and a source of spread of the epidemic. This
study aimed to verify if the lung ultrasound (LUS) had enough high
negative predictive value to rule out coronavirus disease 2019
(COVID-19) among a population of healthcare workers operating in the
Emergency Department. Methods: A multicenter prospective observational
study was conducted, enrolling healthcare workers among the staff of two
Emergency Departments in Northeast Italy. The definitive diagnosis of
COVID-19 was established by an adjudication committee, based on the
clinical data and RT-PCR on nasopharyngeal swab result. Results: From
March 30, 2020, to April 22, 2020, we enrolled 155 cases. The
adjudication committee determined two true positives for COVID-19.
Twenty-one healthcare workers presented suggestive symptoms (2 true
positives and 19 false positives). The nasopharyngeal swab was positive
in one case (1 false-negative case). LUS was suggestive for COVID-19
pneumonia in 4 cases (2 false-positive cases). The diagnostic accuracy
of LUS was 98.7% (95% CI 95.4%-99.8%). The sensitivity and the
specificity of LUS were 100% (95% CI 15.8% -100%) and 98.7% (95%
CI 95.4% - 99.8%), respectively. The negative predictive value was
100% (95% CI 100% -100%). Conclusion: LUS has a good enough negative
predictive value for ruling out COVID-19 in a population of healthcare
workers exposed to COVID-19.