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Fernández-Codina, Andreu; Sempere-González, Abiu; Cañas-Ruano, Esperanza

doi:10.1016/j.medcle.2022.10.008

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Furthermore, they considered that detecting COVID-19 patients with LUS would allow to separate them from the rest of the patients quicker, moving them fewer times around the ED. This could reduce the risk of nosocomial spread of the virus. LUS has a fairly better capacity of diagnosing pneumonia compared to CXR. Pneumonia is the hallmark of lung damage and subsequent complications in COVID-19 patients. It is convenient: it can be done at the bedside, no radiations are needed, and it can help to discern which patient would benefit from an extended inhospital stay. Our colleagues propose the integration of LUS in our original COVID-19 ED flow algorithm as a second line test for patients with CXR ruling out pneumonia or for those who could have a contraindication for radiation-based tests.Our diagnostic approach to COVID-19 has radically changed since 2020. The affordable and quick rapid antigen tests (RAT) have replaced PCR for first line testing, especially in mild symptomatic COVID-19 patients.<a class="elsevierStyleCrossRef" href="#bib0030">2</a> In 15–30min, we can have a diagnosis, and tests are available in the pharmacies so that patients might come to the ED with a COVID-19 diagnosis already done. Triage for suspected COVID-19 can now be effectively done upon ED admission with RAT and a severity scoring tool like the Andorran triage model. There is almost no role for imaging in COVID-19 infection diagnosis at this point.Morbidity and mortality secondary to COVID-19 have plummeted. Incidence of pneumonia, hospitalization, or death in the different Omicron variants have decreased compared to previous variants.<a class="elsevierStyleCrossRef" href="#bib0035">3</a> This factor, along with effective vaccination campaigns and treatments, has made less likely the eventual EDs’ COVID-19-related overflow with a great number of patients at risk for complications. We think that in that given setting, limitations including ultrasound machine availability, the need for trained staff in adequate numbers, the inter-operator data interpretation variability, and the time allocated for each exam (5–7min at best but likely more: e.g. cleaning the device/changing the probe cover, getting the physician to another room, getting the next patient ready) would still pose a serious feasibility issue. CXR can reach an acceptable sensitivity with a very low mortality (0.003%) in patients with no radiologic findings of pneumonia, as we showed. We still think it is the first and most convenient screening tool for COVID-19 pneumonia in patients with mild involvement. LUS can have a paper as an ancillary test.<a class="elsevierStyleCrossRef" href="#bib0040">4</a> It's added benefit in CXR negative patients is nowadays questionable given Omicrons’ generally benign course and the reduction of complications associated to vaccination making them unlikely in general population. Nonetheless, we agree it can have a role in selected patients with CXR contraindications with risk factors for complications, or when CXR is not diagnostic and there is a strong suspicion for COVID-19-related pneumonia.FundingNone for this specific manuscript.Conflicts of interestNone for this specific manuscript." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:2 [ "identificador" => "xack650573" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "Members of the Vall d’Hebron University Hospital COVID 19 ED research group: María Arranz-Betegón, Esperanza Cañas-Ruano, Eva Domingo-Baldrich, Andreu Fernández-Codina, Eloi García-Vives, Albert Gil-Vila, Jordi Llaneras-Artigues, Beatriz Meza, Xabier Michelena, Olimpia Orozco-Gálvez, Iago Pinal-Fernández, Sheila Romero-Ruperto, Francesc Sanpedro-Jiménez, Abiu Sempere-González, and Javier Sarrapio-Lorenzo." "etiqueta" => "Appendix A" "titulo" => "Appendix A" "identificador" => "sec0015" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiography-based triage for COVID-19 in the Emergency Department in a Spanish cohort of patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sempere-González" 1 => "J. Llaneras-Artigues" 2 => "I. Pinal-Fernández" 3 => "E. Cañas-Ruano" 4 => "O. Orozco-Gálvez" 5 => "E. Domingo-Baldrich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2022" "volumen" => "158" "paginaInicial" => "466" "paginaFinal" => "471" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Dinnes" 1 => "P. Sharma" 2 => "S. Berhane" 3 => "S.S. van Wyk" 4 => "N. Nyaaba" 5 => "J. Domen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD013705.pub3" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2022" "volumen" => "7" "paginaInicial" => "CD013705" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35866452" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical severity of SARS-CoV-2 Omicron BA.4 and BA.5 lineages compared to BA.1 and Delta in South Africa" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Wolter" 1 => "W. Jassat" 2 => "S. Walaza" 3 => "R. Welch" 4 => "H. Moultrie" 5 => "M.J. Groome" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41467-022-33614-0" "Revista" => array:5 [ "tituloSerie" => "Nat Commun" "fecha" => "2022" "volumen" => "13" "paginaInicial" => "5860" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36195617" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The diagnostic performance of lung ultrasound for detecting COVID-19 in emergency departments: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Jari" 1 => "A.M. Alfuraih" 2 => "J.R. McLaughlan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jcu.23184" "Revista" => array:6 [ "tituloSerie" => "J Clin Ultrasound" "fecha" => "2022" "volumen" => "50" "paginaInicial" => "618" "paginaFinal" => "627" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35261033" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack650573" "titulo" => "Acknowledgements" "texto" => "None." 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ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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Vol. 160. Issue 3.

Pages 140-141 (February 2023)

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