On December 31st 2019, Chinese authorities referred the presence of a cluster of 27 cases of atypical pneumonia of unknown etiology in the city of Wuhan, province of Hubei. On January 9th 2020, the Chinese Center for Disease Control and Prevention officially declared that they had identified and isolated the causative agent, a new β-coronavirus, first named 2019-nCoV and then officially renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses (Feb 11th, 2020). The World Health Organization (WHO) declared the SARS-CoV-2 outbreak as a Public Health Emergency of International Concern (PHEIC) on 30th January 2020 and a pandemic on 11th March 2020. As of August 1st, there have been 17,396,943 confirmed cases of COVID-19 and 675,060 deaths reported by the World Health Organization (WHO). Prompt identification of suspect cases and confirmation through laboratory testing is of paramount importance in the context of a pandemic, due to the urgent need of strict isolation measures for infected patients. Therefore, patients with clinical suspicion for COVID-19 but a first negative nasopharyngeal swab (NPS) represent an important clinical challenge, as a false negative result carries a high risk of spreading an unrecognized infection. In the Emergency Department, if a suggestive clinical picture is integrated with the use of a bedside lung ultrasound (LUS), repeating a second NPS and continuing to manage the patient as a “potential suspect case” is suggested. We analyzed 431 patients admitted to the ED with suspected COVID-19 and a negative NPS. Their LUS score was evaluated with a 12-window approach. Afterwards, NPS was repeated in 211 patients, resulting positive in 32. Moreover, serological methods identified an additional 34 patients. Clinical presentation, comorbidities, LUS score and P/F ratio were significantly different in the population in whom the second NPS was not deemed necessary, meaning that the population with a false negative result at the first NPS can be identified on clinical basis integrated with the use of LUS.
Lung US in the Emergency Department: role in the diagnosis of COVID-19 in patients with a first falsely negative nasopharyngeal swab
PAVLYSHYN, MAR'YANA
2019/2020
Abstract
On December 31st 2019, Chinese authorities referred the presence of a cluster of 27 cases of atypical pneumonia of unknown etiology in the city of Wuhan, province of Hubei. On January 9th 2020, the Chinese Center for Disease Control and Prevention officially declared that they had identified and isolated the causative agent, a new β-coronavirus, first named 2019-nCoV and then officially renamed SARS-CoV-2 by the International Committee on Taxonomy of Viruses (Feb 11th, 2020). The World Health Organization (WHO) declared the SARS-CoV-2 outbreak as a Public Health Emergency of International Concern (PHEIC) on 30th January 2020 and a pandemic on 11th March 2020. As of August 1st, there have been 17,396,943 confirmed cases of COVID-19 and 675,060 deaths reported by the World Health Organization (WHO). Prompt identification of suspect cases and confirmation through laboratory testing is of paramount importance in the context of a pandemic, due to the urgent need of strict isolation measures for infected patients. Therefore, patients with clinical suspicion for COVID-19 but a first negative nasopharyngeal swab (NPS) represent an important clinical challenge, as a false negative result carries a high risk of spreading an unrecognized infection. In the Emergency Department, if a suggestive clinical picture is integrated with the use of a bedside lung ultrasound (LUS), repeating a second NPS and continuing to manage the patient as a “potential suspect case” is suggested. We analyzed 431 patients admitted to the ED with suspected COVID-19 and a negative NPS. Their LUS score was evaluated with a 12-window approach. Afterwards, NPS was repeated in 211 patients, resulting positive in 32. Moreover, serological methods identified an additional 34 patients. Clinical presentation, comorbidities, LUS score and P/F ratio were significantly different in the population in whom the second NPS was not deemed necessary, meaning that the population with a false negative result at the first NPS can be identified on clinical basis integrated with the use of LUS.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
Per maggiori informazioni e per verifiche sull'eventuale disponibilità del file scrivere a: unitesi@unipv.it.
https://hdl.handle.net/20.500.14239/11685