To the Editor: We read with great interest the CIMUS Expert Consensus Statement on the use of Lung Ultrasound for inpatients with known of suspected COVID‐19. 1
Among general statements, we completely agree with the strong recommendation given for the necessity to scan posterior zones, wherever possible, in addition to the usual lung scan regions.
However, we have to raise a concern in relation to this sentence “Although a number of Lung ultrasonography (LUS)‐scanning protocols have been proposed for COVID‐19, there currently are no data to support the use of one protocol over another”. Our proposal of international standardization of LUS approach for COVID‐19 patients 2 has been cited in relation to that sentence.
Differently than what stated, our proposal has been validated both in relation to other acquisition protocols and for its prognostic value.
Firstly, we demonstrated the necessity to perform extended evaluations that does not exclude posterior landmarks, 3 also comparing LUS findings with computed tomography scan of the chest.
Secondly, we have shown how important it is to intercept high (>24) cumulative LUS scores (defined as the sum of the scores on the 14 acquisition areas), in order to predict the probability of clinical worsening of SARS‐CoV‐2 pneumonia. 4
Finally, we compared the outcome of three different acquisition protocols (respectively, based on 4, 8, and 12 acquisition areas) with our protocol, which is based on 14 acquisition areas. Results showed how only a 12 and 10 (8 plus 2‐basal‐posterior areas) acquisition areas protocol had acceptable level of agreement with standard 14 acquisition areas protocol. 5
To conclude, substantial literature has been produced in order to validate our proposal. With respect to other acquisition protocols, there are currently sufficient data to support the use of our protocol over others.
All authors equally contributed to this study.
References
- 1. Ma IWY, Hussain A, Wagner M, et al. Canadian Internal Medicine Ultrasound (CIMUS) Expert Consensus Statement on the use of lung ultrasound for the assessment of medical inpatients with known or suspected coronavirus disease 2019. J Ultrasound Med 2020. 10.1002/jum.15571. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Soldati G, Smargiassi A, Inchingolo R, et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID‐19: a simple, quantitative, reproducible method. J Ultrasound Med 2020; 39:1413–1419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Smargiassi A, Soldati G, Torri E, et al. Lung ultrasound for COVID‐19 patchy pneumonia: extended or limited evaluations? J Ultrasound Med 2020. 10.1002/jum.15428. [DOI] [PubMed] [Google Scholar]
- 4. Perrone T, Soldati G, Padovini L, et al. A new lung ultrasound protocol able to predict worsening in patients affected by severe acute respiratory syndrome coronavirus 2 pneumonia. J Ultrasound Med 2020. 10.1002/jum.15548. [DOI] [PubMed] [Google Scholar]
- 5. Mento F, Perrone T, Macioce VN, et al. On the impact of different lung ultrasound imaging protocols in the evaluation of patients affected by coronavirus disease 2019: how many acquisitions are needed? J Ultrasound Med 2020. 10.1002/jum.15580. [DOI] [PMC free article] [PubMed] [Google Scholar]