• Emanuele Pivetta, Alberto Goffi, Maria Tizzani, Stefania M Locatelli, Giulio Porrino, Isabel Losano, Dario Leone, Gilberto Calzolari, Matteo Vesan, Fabio Steri, Arianna Ardito, Marialessia Capuano, Maria Gelardi, Giulia Silvestri, Stefania Dutto, Maria Avolio, Rossana Cavallo, Alice Bartalucci, Cristina Paglieri, Fulvio Morello, Lorenzo Richiardi, Milena M Maule, Enrico Lupia, and Molinette MedUrg Group on Lung Ultrasound.
• Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy. Electronic address: emanuele.pivetta@gmail.com.
• Ann Emerg Med. 2021 Apr 1; 77 (4): 385394385-394.

Study ObjectiveAccurate diagnostic testing to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is critical. Although highly specific, SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) has been shown in clinical practice to be affected by a noninsignificant proportion of false-negative results. This study seeks to explore whether the integration of lung ultrasonography with clinical evaluation is associated with increased sensitivity for the diagnosis of coronavirus disease 2019 pneumonia, and therefore may facilitate the identification of false-negative SARS-CoV-2 RT-PCR results.MethodsThis prospective cohort study enrolled consecutive adult patients with symptoms potentially related to SARS-CoV-2 infection who were admitted to the emergency department (ED) of an Italian academic hospital. Immediately after the initial assessment, a lung ultrasonographic evaluation was performed and the likelihood of SARS-CoV-2 infection, based on both clinical and lung ultrasonographic findings ("integrated" assessment), was recorded. RT-PCR SARS-CoV-2 detection was subsequently performed.ResultsWe enrolled 228 patients; 107 (46.9%) had SARS-CoV-2 infection. Sensitivity and negative predictive value of the clinical-lung ultrasonographic integrated assessment were higher than first RT-PCR result (94.4% [95% confidence interval {CI} 88.2% to 97.9%] versus 80.4% [95% CI 71.6% to 87.4%] and 95% [95% CI 89.5% to 98.2%] versus 85.2% [95% CI 78.3% to 90.6%], respectively). Among the 142 patients who initially had negative RT-PCR results, 21 tested positive at a subsequent molecular test performed within 72 hours. All these false-negative cases were correctly identified by the integrated assessment.ConclusionThis study suggests that, in patients presenting to the ED with symptoms commonly associated with SARS-CoV-2 infection, the integration of lung ultrasonography with clinical evaluation has high sensitivity and specificity for coronavirus disease 2019 pneumonia and it may help to identify false-negative results occurring with RT-PCR.Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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