COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment, Diagnosis Hussain A, Via G, Melniker L, et al. Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus. Crit Care. 2020 Dec 24;24(1):702. doi: 10.1186/s13054-020-03369-5.
Abstract

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

Ratings
Discipline / Specialty Area Score
Emergency Medicine
Intensivist/Critical Care
Hospital Doctor/Hospitalists
Internal Medicine
Cardiology
Respirology/Pulmonology
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Comments from MORE raters

Emergency Medicine rater

Instructive scoping review and consensus panel on multi-purpose applications of point-of-care ultrasound in the evaluation and management of COVID-19 patients. The methods by which authors "GRADEd" the evidence (who performed assessments using what structure/criteria) is unclear as are the specific sub-types of diagnostic bias (incorporation, differential verification, imperfect criterion standard, etc - see https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14048). Nonetheless. This is an instructive document on which to build local POCUS protocols.

Emergency Medicine rater

This is a consensus document on POCUS for the diagnosis of COVID19 and for ongoing management in critical COVID19 patients. Although this review has a nice summary of recommendations, it`s important to note the following: 1) the studies cited for evidence directly related to COVID-19 are mainly observational; 2) the recommendations are built on a modified Delphi technique from an expert panel in ultrasound. The latter may create an intellectual bias on their recommendations. This may be appropriate for those proficient in ultrasound, but the recommendations may not be applicable for everyone, especially those who are not proficient.

Hospital Doctor/Hospitalists rater

Very broad in scope and is more of a cataloging of all possible uses of ultrasound in COVID patients. Many recommendations are general or intuitive; some are useful, many less so.

Hospital Doctor/Hospitalists rater

POCUS is becoming an increasingly popular diagnostic tool and soon will become a must-have tool for clinicians. During the COVID pandemic, sharing a US machine poses an infection transmission risk unless it is thoroughly decontaminated or designed only for the COVID unit.

Intensivist/Critical Care rater

A useful summary of POCUS in COVID with guidance / recommendations. Most of the data are not new and come from non-COVID studies and patients, but still helpful.

Intensivist/Critical Care rater

Very interesting study. May be more widely applicable beyond just the COVID issues discussed.

Intensivist/Critical Care rater

This is a very nice consensus document on the potential use of ultrasound in COVID-19. Although not a formal guideline per se, this provides helpful guidance for users of POCUS, particularly with the increasing availability of small portable ultrasound machines.

Respirology/Pulmonology rater

This is a concise, but meaty, review of the literature on the use of lung, cardiac, and other ultrasonic procedures in the diagnosis and management of organ involvement and function in COVID-19 infection. Potential applications are discussed and preliminary recommendations of ultrasound use in COVID-19 infections are made.