Lung Ultrasound Can Predict Clinical Progression of Severe COVID-19 Patients, Finds Study

Lung ultrasound, considered a simple method for diagnosing lung disease, can also help predict the clinical progression of severe COVID-19 patients, according to a new study reported by Agência FAPESP.

Given the importance of diagnostic imaging of the lungs to the treatment of severe COVID-19 patients, researchers at the University of São Paulo’s Medical School (FM-USP; São Paulo City, Brazil) assumed it could also be useful to screen patients admitted with the infection based on predicted outcome. They chose lung ultrasound to test the hypothesis because the method is widely used in ERs, as well as being fast, easy to perform with portable equipment, and inexpensive. In the study, the team applied an ultrasound examination protocol covering 12 lung regions in 180 COVID-19 patients undergoing treatment at the hospital.


The study subjects were patients diagnosed by RT-PCR and admitted to the hospital between March and May 2020, in the initial stages of the pandemic. The researchers performed lung ultrasound exams on the volunteers and calculated their scores on the day of admission to the ER. The median age of the subjects was 60, and well over half (58%) were male. The scoring methodology, known as the LUS protocol, entailed examining 12 lung regions in the anterior, lateral, and posterior aspects of the chest wall on both sides. Each region was evaluated by aeration pattern, with scores ranging from zero to 3 points according to the worst pattern observed. The final score was the sum of points in all 12 regions, ranging from zero to 36.

The results showed that the higher the lung ultrasound score, the greater the risk of admission to an intensive care unit (ICU), intubation, and death. Patients scoring 14-16 were most likely to require ICU care, and a fatal outcome was most likely for those with scores above 20. The average LUS was 18.7, with a standard deviation of 6.8. Of the 180 patients enrolled, 109 (60%) were discharged alive, 74 (56%) were treated in the ICU, 52 (39%) were intubated and 61 (33%) died.

“We found lung ultrasound to be a good predictor of the need for intensive care with endotracheal intubation and the risk of death for COVID-19 patients admitted to the emergency room. It can be a simple, cheap way to estimate the prognosis for patients infected by the virus,” Heraldo Possolo de Souza, principal investigator for the study, told Agência FAPESP.

“Point-of-care lung ultrasound is extremely important in the pandemic. It can be performed at the bedside by ER staff who don’t need to be as highly trained to interpret the images as they do in the case of a chest CT scan, for example,” said Julio Cesar Garcia de Alencar, the first author of the article on the study.

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