Letter to the Editor
Reply
Respuesta
Andreu Fernández-Codinaa,b,c,
, Abiu Sempere-Gonzáleza,d, Esperanza Cañas-Ruanoa,e, for the Vall d’Hebron University Hospital COVID 19 ED research group
Corresponding author
a Emergency Department, University Hospital Vall d’Hebron, Barcelona, Spain
b Rheumatology Division and General Internal Medicine Department-Windsor Campus, Western University, London, ON, Canada
c Systemic Autoimmune Diseases Division and Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain
d Infectious Diseases Department, Hospital Clinic, Barcelona, Spain
e Infectious Diseases Department, Hospital del Mar, Barcelona, Spain
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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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">2</span></a> In 15–30<span class="elsevierStyleHsp" style=""></span>min, 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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3</span></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 (5–7<span class="elsevierStyleHsp" style=""></span>min 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"><span class="elsevierStyleSup">4</span></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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None for this specific manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None for this specific manuscript.</p></span></span>" "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" => "<p id="par0040" class="elsevierStylePara elsevierViewall">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.</p>" "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" => "<p id="par0035" class="elsevierStylePara elsevierViewall">None.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000003/v1_202302051543/S2387020623000244/v1_202302051543/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000003/v1_202302051543/S2387020623000244/v1_202302051543/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000244?idApp=UINPBA00004N" ]
