Do lung ultrasound abnormalities change during hospitalization for COVID-19?

Background. While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized. Methods. We studied 413 LUS scans in 244 participants >= 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and%lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure. Results. Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1;Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001;Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36). Conclusion. Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

Acute to Chronic Pain Signatures Program (a2CPS): Implementation of Remote Training for a Multisite Observation Study During COVID-19

Chronic pain produces the largest non-fatal burden of disease, yet our understanding of factors that contribute to the transition from acute chronic pain are poorly understood. The Acute to Chronic Pain Signatures Program (A2CPS) is a longitudinal, multi-site observational study to identify biomarkers (individual or biosignature combinations) that predict susceptibility or resilience to the development of chronic pain after surgery (knee replacement or thoracotomy). Due to the COVID-19 pandemic, however, travel between sites was restricted just as the study was preparing to begin enrollment. Here, we present multiple training protocol adaptations that were successfully implemented to facilitate remote research-related training. The A2CPS consortium includes 2 Multisite Clinical Centers (MCCs, 10 recruitment sites), a Clinical Coordinating Center (CCC), a Data Integration and Resource Center (DIRC), 3 Omics Data Generation Centers, and representation from the NIH Pain Consortium, Common Fund, and National Institute of Drug Abuse. The A2CPS is collecting candidate and exploratory biomarkers including pain, fatigue, function, sleep, psychosocial factors, quantitative sensory testing (QST), genomics, proteomics, metabolomics, lipidomics, and brain imaging. The CCC adapted the A2CPS training and evaluation techniques for certifying the MCCs to ensure competency with recruitment, assessments (surveys, QST, function), and data entry across clinical sites using a combination of virtual training sessions, standardized quantitative measurements, video demonstrations, and reliability assessments. Staff at data collection sites have been successfully certified in all psychophysical assessments (QST, function). This included use of stop watches and metronomes to ensure standard application rates, completion of application-rate and inter-rater-reliability worksheets at each clinical site, designation of site-specific master examiners, training rubrics and video demonstration to verify competency was harmonized across sites. Adaptation of training protocols to a remote format enabled initiation of subject enrollment while maintaining documented standards with high data completion rates for surveys and assessments. The A2CPS Consortium is supported by the National Institutes of Health Common Fund, which is managed by the OD/Office of Strategic Coordination (OSC). Consortium components include: Clinical Coordinating Center (UO1NS077179), Data Integration and Resource Center (UO1NS077352), Omics Data Generation Centers (U54DA049116, U54DA049115, U54DA09113), and Multisite Clinical Centers: MCC 1 (UM1NS112874) and MCC 2 (UM1NS118922). Postdoctoral support for GB provided by the National Institutes of Neurological Disease and Stroke (NINDS) of the NIH under Award Number U24NS112873-03S2.