How Is COVID ‐19 Changing Lung Ultrasound? A Survey by the Thoracic Ultrasound Academy
July 16, 2020 — Journal of Ultrasound in Medicine
We thank all Accademia di Ecografia Toracica members for their enthusiasm in taking part in the group’s activities and their strength in fighting COVID‐19 and sharing their knowledge about it.
Since the beginning of the coronavirus disease 2019 (COVID‐19) epidemic in Italy, given the first evidence of the usefulness of lung ultrasound (LUS),1 there has been increasing interest about the technique amid physicians in the whole nation, as testified by case reports, letters, research reports,2-4 and experiences shared via social network scientific groups. In particular, our discussion group, Accademia di Ecografia Toracica (Thoracic Ultrasound Academy),5 numbering about 1700 members in February 2020, had a huge increase in members (physicians with an interest in chest ultrasound [US]) during the COVID outbreak, reaching 4000 members on May 19, 2020. Different strategies, in particular webinars, video tutorials, and local teaching programs, were enacted to spread knowledge about LUS.6-8 Moreover, as urgent measures, many hospitals have increased their US equipment through emergency approvals for purchasing new US systems and foundation donations.
With the aim of understanding and estimating the growth of LUS, we designed a 1‐week survey that was submitted to our scientific discussion group (the audience was about 4000 members). The invitation was published as a link to the survey in the discussion group and was active for 1 week with daily reminders.
The survey included 10 questions about working activity during the COVID outbreak (location, occupation, aim of US examinations, and number of US examinations performed before and during the outbreak), LUS learning, and US equipment acquisition. Only anonymous data were collected in the survey. Informed consent was not applicable, and Ethics Committee approval was not required. The survey was open from May 19 to 27, 2020. The final number of respondents was 123, and the general results of the survey are summarized in online supplemental Table 1.
Respondents were mostly from northern Italy (49.6%), principally working in COVID wards (34.2%), COVID‐free wards (26%), emergency departments (20.3%), and intensive/semi‐intensive care units (30.9%). Only 14.6% of the respondents started using LUS because of the epidemic. Forty‐three (34.9%) recently learned LUS, 81.4% of them following video tutorials and webinars and 18.6% following local courses or mentoring with experts. The mean experience in LUS ± SD was 5.3 ± 4.4 years (median, 5 years). The mean numbers of LUS examinations performed daily before and during the epidemic were 2.8 ± 3.2 and 7 ± 10, respectively, with an average increase of 250%. The numbers of examinations performed before and during the epidemic were compared by a paired t test, showing a significant difference (P < .0001). Experienced operators seemed to perform a larger number of LUS examinations: the linear regressions between years of experience in LUS and the number of LUS examinations performed daily before and during the COVID‐19 epidemic were significant (P < .0001; P = .0064). With the respondents who had years of experience equal to or exceeding the median value (5 years) considered an “expert group,” the mean numbers of LUS examinations performed during the epidemic by respondents with experience of 5 years or greater and those with experience of less than 5 years were 9 ± 13.1 and 4.7 ± 4.3. The unpaired t test showed a significant difference (P = .019).
Overall, 75.6%, 57.5%, and 66.4% of respondents said that LUS examinations has increased in number, quality, and accuracy, respectively. In particular, 85.7%, 82.9%, and 82.9% of the respondents in the group trained with webinar/video tutorials increased the number, quality, and accuracy of their LUS examinations. The principal aims of LUS examinations during the COVID epidemic were pneumonia monitoring (63.4%) and screening (60.2%). Sixty‐five respondents reported the acquisition of new US equipment, mostly wheeled portable US systems (37.4%) and handheld or wireless US systems (18.7%). Thirteen of 65 (20%) acquired more than 1 US device, mostly handheld and wheeled portable US systems.
Our study had some limitations. In particular, the number of respondents was limited, probably because the survey, published in a social network group and not sent to each invited user, was noted only by most active users; moreover, the time of the survey was determined by the number of daily answers: an initial peak was observed in the first 2 days, but despite daily reminders, there was a global decline in responses, and on the last day, only 1 user participated. Consequently, a longer duration of the survey would not have influenced the results significantly. The low number of respondents, in comparison with the number of group members, tells us that many users presumably actually have limited activity in the group.
In conclusion, our data document the finding that the fight against the COVID‐19 epidemic has led to an increase in LUS. Thanks to online resources, many operators could e‐learn and apply the technique, but in particular, experienced operators showed a marked increase in the number of examinations performed, also thanks to the acquisition of new US equipment. What we are learning from this pandemic is the importance of LUS in the diagnosis, evaluation, and monitoring of pneumonia, which, in the hands of many physicians, not only respiratory, could improve the quality of the treatment of respiratory patients.
Authors: Alessandro Zanforlin MD, PhD, Francesco Tursi MD, on behalf of the Accademia di Ecografia Toracica Group