Point Of Care UltraSonography for Risk-stratification of COVID-19 Patients

NCT ID: NCT04338100

Last Updated: 2022-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

307 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-04-08

Study Completion Date

2020-06-23

Brief Summary

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COVID-19 pandemic has developed worldwide in less than 4 months. While most patients have a mild or uncomplicated disease (80%), approximately 15% need hospital care and 5% intensive care. Severe cases are characterized by pulmonary involvement which may progress to acute respiratory distress syndrome (ARDS). Early identification of patients who are likely to get worse is therefore a major issue.

While, chest X-ray has poor diagnostic performances, pulmonary computed tomography (CT scan) seems very sensitive (97%) and quite specific of COVID-19. Sub-pleural bilateral ground-glass pattern can precede the positivity of RT-PCR for SARS-CoV-2. CT scan is now considered as the best imaging test to assess COVID-19 patients and is recommended as first-line diagnosis tool by the French Society of Radiology (SFR). However, performing CT scan in all or many patients with suspected COVID-19 may result in radiology department overload, especially, taking into account bio-cleaning between patients. Moreover, CT scan may lead to adverse effects including induced cancer due to the cumulative diagnostic irradiation.

Chest ultrasonography may be an alternative to CT scan. It is a simple, non-invasive, non-irradiating, inexpensive and available at the point of care (POCUS). Most of emergency physicians and many other specialists (pneumologists, infectious disease or intensive care physicians) are trained to perform chest POCUS and use it in their everyday practice. Multiple studies have demonstrated its superiority to chest X-ray for the detection of pneumonia. In ARDS, a scoring has been developed and has shown good correlation with mortality. POCUS is very effective in detecting peripheral patterns and seems appropriate to explore COVID-19 patients.

Previous studies suggest its interest in SARSCov2 infections for initial patient assessment and identification of lung damage. However, its performances have never been scientifically evaluated to date.

Our main hypothesis is that point of care lung ultrasonography performed during the initial examination may identify high-risk COVID-19 patients.

Detailed Description

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Patients consulting in the emergeny department of participating centres for suspected or confirmed COVID-19 are checked for inclusion and non-inclusion criteria and asked for study participation.

Including patients have point-of-care lung ultrasonography (POCUS) performed within 48 hours following ED admission. The severity of lung damage is assessed using the lung ultrasonography score on 36 points for ARDS (POCUS score).

Apart POCUS score assessment, patients are managed as usual.

If a chest CT scan is performed, its result is collected and, in particular, the quantification of the extent of pulmonary lesions in percentage from 0 to 100%, carried out according to the recommendations of the French Society of Radiology.

For hospitalized patients, if possible, a second chest ultrasonography is performed on Day 5 +/- 3. The extent of lung damage is assessed by the POCUS score.

A follow-up is carried out on day 14 (D14) and the patient's status according to the "Ordinal Scale for Clinical Improvement" for COVID-19 from WHO is recorded.

Conditions

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COVID Coronavirus Infection

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Chest Ultrasound

Only one arm, all included patients having chest ultrasonography.

Follow-up at 14 days

Intervention Type PROCEDURE

Point of care chest ultrasonography and 14-day follow-up to assess the evolution of the infection and care requirement (invasive ventilation or death)

Interventions

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Follow-up at 14 days

Point of care chest ultrasonography and 14-day follow-up to assess the evolution of the infection and care requirement (invasive ventilation or death)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patient with COVID-19 confirmed by positive RT-PCR or considered as probable by the in-charge physician,
* ≥18 years old,
* Not requiring respiratory assistance and/or other intensive care
* Not subject to a limitation of active therapeutics

Exclusion Criteria

* History of pneumonectomy
* Any reason making chest ultrasonography impossible
* Any reason making 14-day follow-up impossible
* Patient opposition to research participation.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Angers

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Philippe LE CONTE, Pr

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Nantes

Thomas FLAMENT, Dr

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Tours

Louis SOULAT, Pr

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Rennes

Nicolas MARJANOVIC, Dr

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Poitiers

Francis COUTURAUD, Dr

Role: PRINCIPAL_INVESTIGATOR

University Hospital of Brest

Laure BAUDIN, Dr

Role: PRINCIPAL_INVESTIGATOR

Hospital of Cholet

Karim TAZAROURTE, Pr

Role: PRINCIPAL_INVESTIGATOR

Hospices Civils de Lyon (University Hospital of Lyon)

Thomas DELOMAS, Dr

Role: PRINCIPAL_INVESTIGATOR

Hospital of Saint-Lô

Luc-Marie JOLY, Pr

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Rouen

Locations

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Florence DUPRIEZ

Brussels, , Belgium

Site Status

MORIN François

Angers, , France

Site Status

COUTURAUD Francis

Brest, , France

Site Status

BAUDIN Laure

Cholet, , France

Site Status

TAZAROURTE Karim

Lyon, , France

Site Status

LE CONTE Philippe

Nantes, , France

Site Status

MARJANOVIC Nicolas

Poitiers, , France

Site Status

SOULAT Louis

Rennes, , France

Site Status

JOLY Luc-Marie

Rouen, , France

Site Status

DELOMAS Thomas

Saint-Lô, , France

Site Status

FLAMENT Thomas

Tours, , France

Site Status

Countries

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Belgium France

References

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Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28.

Reference Type RESULT
PMID: 32109013 (View on PubMed)

Rodriguez-Morales AJ, Cardona-Ospina JA, Gutierrez-Ocampo E, Villamizar-Pena R, Holguin-Rivera Y, Escalera-Antezana JP, Alvarado-Arnez LE, Bonilla-Aldana DK, Franco-Paredes C, Henao-Martinez AF, Paniz-Mondolfi A, Lagos-Grisales GJ, Ramirez-Vallejo E, Suarez JA, Zambrano LI, Villamil-Gomez WE, Balbin-Ramon GJ, Rabaan AA, Harapan H, Dhama K, Nishiura H, Kataoka H, Ahmad T, Sah R; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. doi: 10.1016/j.tmaid.2020.101623. Epub 2020 Mar 13.

Reference Type RESULT
PMID: 32179124 (View on PubMed)

Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008 Jul;134(1):117-25. doi: 10.1378/chest.07-2800. Epub 2008 Apr 10.

Reference Type RESULT
PMID: 18403664 (View on PubMed)

Zhao Z, Jiang L, Xi X, Jiang Q, Zhu B, Wang M, Xing J, Zhang D. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med. 2015 Aug 23;15:98. doi: 10.1186/s12890-015-0091-2.

Reference Type RESULT
PMID: 26298866 (View on PubMed)

Morin F, Douillet D, Hamel JF, Rakotonjanahary J, Dupriez F, Savary D, Aube C, Riou J, Dubee V, Roy PM. Point-of-care ultrasonography for risk stratification of non-critical COVID-19 patients on admission (POCUSCO): a study protocol of an international study. BMJ Open. 2021 Feb 10;11(2):e041118. doi: 10.1136/bmjopen-2020-041118.

Reference Type DERIVED
PMID: 33568367 (View on PubMed)

Related Links

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https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3544750

A Preliminary Study on the Ultrasonic Manifestations of Peripulmonary Lesions of Non-Critical Novel Coronavirus Pneumonia (COVID-19)

Other Identifiers

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2020-A00782-37

Identifier Type: -

Identifier Source: org_study_id

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