Table 1.
Recommendations on the Use of Lung POCUS in the Assessment of Medical Inpatients With Known or Suspected COVID‐19
| Recommendation | Strengtha |
|---|---|
| General | |
| 1. In addition to the usual lung scan regions, posterior lung zones of the patient should be scanned wherever possible. | Strong2 |
| 2. Pneumonitis on LUS imaging is supported by the following findings: pleural irregularity; patchy B‐lines that may be focal, multifocal, or confluent; subpleural consolidation; and localized/focal pleural effusion. These findings may be present in any combination and are not diagnostic of COVID‐19. | Strong1 |
| 3. In patients with preexisting pleural or interstitial lung disease, we recommend that LUS findings be interpreted with caution. | Strong1 |
| 4. Presence of any of the following on LUS imaging should prompt an additional workup, as these are considered less likely for COVID‐19: large consolidation and large or complex pleural effusion. | Strong1 |
| 5. In a patient with suspected COVID‐19, while performing the LUS examination, we recommend evaluating concurrently for the presence/absence of pneumothorax. | Strong2 |
| 6. We do not recommend that admission decisions be made on the basis of the severity of LUS findings. | Weak3 |
| 7. We do not recommend that discharge decisions be made on the basis of LUS findings. | Weak3 |
| 8. For admitted patients, we do not recommend that serial LUS examinations be performed routinely without a change in the clinical condition. | Weak2 |
| 9. For admitted patients, serial LUS examinations should be performed in the presence of a change in the clinical status. | Strong2 |
| Assessment of patients with moderate or severe symptoms | |
| 10. LUS should be the initial imaging of choice. | Strong3 |
| 11. Positive LUS findings for pneumonitis would not diagnose COVID‐19 but would support the diagnosis of pneumonitis. | Strong1 |
| 12. Positive LUS findings for pneumonitis may preclude the need to pursue additional imaging if the pretest probability of an alternative or superimposed diagnosis is low. | Strong2 |
| 13. Entirely negative LUS findings for pneumonitis would make COVID‐19 less likely. An additional workup for other causes of pulmonary symptoms is recommended. | Strong2 |
| If chest radiography has already been performed | |
| 14. If the chest radiographic findings are is negative, an LUS examination should be performed next. | Strong2 |
| 15. If the chest radiographic findings are negative, positive LUS findings for pneumonitis may preclude the need to pursue additional imaging if the pretest probability of an alternative or secondary diagnosis is low. | Strong2 |
| 16. If the chest radiographic findings are negative, negative LUS findings for pneumonitis should prompt an additional workup. | Strong1 |
| 17. If the chest radiographic findings are positive for pneumonitis, and the pretest probability of an alternative or secondary diagnosis is low, an LUS examination should be performed. | Weak3 |
| If a chest CT was already performed | |
| 18. If the chest CT findings are positive for pneumonitis without additional concerning features, and the pretest probability of an alternative or secondary diagnosis is low, we do not recommend performing an LUS examination. | Weak3 |
| 19. If the chest CT findings are negative for pneumonitis or other concerning features such as pulmonary embolism, and the pretest probability of an alternative or secondary diagnosis is low, we do not recommend performing an LUS examination. | Weak4 |
| Assessment of patients with minimal symptoms | |
| 20. LUS should be the initial imaging of choice. | Strong2 |
| If chest radiography has already been performed | |
| 21. Negative chest radiographic findings alone are insufficient for ruling out pneumonitis; additional chest imaging such as LUS is recommended. | Strong2 |
| 22. Negative chest radiographic findings and positive LUS findings would support the diagnosis of pneumonitis. | Strong1 |
| 23. Negative chest radiographic findings and negative LUS findings are sufficient for ruling out pneumonitis; we do not recommend additional imaging if the pretest probability of an alternative or secondary diagnosis is low. | Strong3 |
| 24. Positive chest radiographic findings for pneumonitis without additional concerning features would support the diagnosis of pneumonitis. Additional imaging such as LUS can still be considered. | Weak4 |
a
Superscript number indicates the round in which consensus was achieved.