Lung Ultrasound Improves Outcome Prediction over Clinical Judgment in COVID-19 Patients Evaluated in the Emergency Department
, Emanuele Pivetta 1, Denise Baricocchi 2,3, Jacopo Davide Giamello 2,4, Francesca Risi 1,2, Matteo Vesan 1,2, Michela Chiarlo 5, Giuliano De Stefano 6, Enrico Ferreri 7, Giuseppe Lauria 4, Stefano Podio 2, Peiman Nazerian 6, Franco Aprà 5, Enrico Lupia 1,8, Fulvio Morello 1,8,* and On behalf of the CODED Study Investigators †Round 1
Reviewer 1 Report
Thank you for the opportunity to review your article “Lung ultrasound improves outcome prediction over clinical judgment in COVID-19 patients evaluated in the Emergency Department”
I consider this paper relevant as it evaluates a group of patients with COVID-19 patients with some relevant instrument such as an ultrasound point-of-care.
However, in my opinion, some aspects have to be considered clarifying some aspects.
Methods:
- I suggest identifying which are the 6 ED centers.
- On page 4, about the LUS score:
- Could you explain better how you scored each area? How many points did you assign for each finding?
- You said that 12 areas were scanned, but posteriorly you said that 4 areas were evaluated. Could you explain better?
Discussion:
I missed some previous papers that showed a correlation between LUS and COVID-19 about the ability predicting outcomes, such as:
DOI: 10.1186/s13054-020-03416-1
DOI: 10.4187/respcare.08648
I suggest adding to the discussion.
Author Response
Point 1:
Methods:
- I suggest identifying which are the 6 ED centers.
Response 1:
The characteristics of the participating centers are now detailed on page 3, lines 8-12.
Point 2:
- On page 4, about the LUS score:
- Could you explain better how you scored each area? How many points did you assign for each finding?
- You said that 12 areas were scanned, but posteriorly you said that 4 areas were evaluated. Could you explain better?
Response 2:
We would like to apologize for the insufficient clarity of the original version, and we thank the Reviewer for his/her comment. To improve method explanation and to allow reproducibility, we have now revised the entire section (page 4, lines 7-12), also adding a new explanatory figure 1. The modified LUS score, used to ease standardization in our study, was based on 8 and not on 12 areas (as in the original LUS score, reference number 19) for B-lines, with the addition of a “flat” score of 0, 3 or 6 points for consolidations (absent, unilateral or bilateral).
Point 3:
Discussion:
I missed some previous papers that showed a correlation between LUS and COVID-19 about the ability predicting outcomes, such as:
DOI: 10.1186/s13054-020-03416-1
DOI: 10.4187/respcare.08648
I suggest adding to the discussion.
Response 3:
The first reference was already cited in the Background section. In the same section, we have now added the second reference, as suggested.
Reviewer 2 Report
A large number of patients (521). The authors should describe in the result section the number of consolidations. "or any consolidation" in not clear. How do they see non-subpleural consolidations?
Author Response
A large number of patients (521). The authors should describe in the result section the number of consolidations. "or any consolidation" in not clear. How do they see non-subpleural consolidations?
Response:
We would like to apologize for the insufficient clarity of the original version, and we thank the Reviewer for his/her comment. For the ultrasound methods, we have now revised the entire section (page 4, lines 7-12), and added a new explanatory figure 1. The term “consolidation” has now been defined in the text, per study protocol. Since the term “non-subpleural consolidation” could be equivocal, we are now consistently using the term “consolidation” throughout the manuscript.
Only 10 patients had lung consolidations in our study, in line with a cohort of patients found clinically suitable for home discharge. This was added in the Results section (page 6 line 15).
