{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T21:53:19Z","timestamp":1787003599998,"version":"build-2736575974"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T00:00:00Z","timestamp":1621555200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T00:00:00Z","timestamp":1621555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    With an urgent need for bedside imaging of coronavirus disease 2019 (COVID-19), this study\u2019s main goal was to assess inter- and intraobserver agreement in lung ultrasound (LUS) of COVID-19 patients. In this single-center study we prospectively acquired and evaluated 100 recorded ten-second cine-loops in confirmed COVID-19 intensive care unit (ICU) patients. All loops were rated by ten observers with different subspeciality backgrounds for four times by each observer (400 loops overall) in a random sequence using a web-based rating tool. We analyzed inter- and intraobserver variability for specific pathologies and a semiquantitative LUS score. Interobserver agreement for both, identification of specific pathologies and assignment of LUS scores was fair to moderate (e.g., LUS score 1 Fleiss\u2019 \u03ba\u2009=\u20090.27; subpleural consolidations Fleiss\u2019 \u03ba\u2009=\u20090.59). Intraobserver agreement was mostly moderate to substantial with generally higher agreement for more distinct findings (e.g., lowest LUS score 0 vs. highest LUS score 3 (median Fleiss\u2019 \u03ba\u2009=\u20090.71 vs. 0.79) or air bronchograms (median Fleiss\u2019 \u03ba\u2009=\u20090.72)). Intraobserver consistency was relatively low for intermediate LUS scores (e.g. LUS Score 1 median Fleiss\u2019 \u03ba\u2009=\u20090.52). We therefore conclude that more distinct LUS findings (e.g.,\n                    <jats:italic>air bronchograms<\/jats:italic>\n                    ,\n                    <jats:italic>subpleural consolidations<\/jats:italic>\n                    ) may be more suitable for disease monitoring, especially with more than one investigator and that training material used for LUS in point-of-care ultrasound (POCUS) should pay refined attention to areas such as\n                    <jats:italic>B-line<\/jats:italic>\n                    quantification and differentiation of intermediate LUS scores.\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-90153-2","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T06:02:50Z","timestamp":1621576970000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Point-of-care lung ultrasound in COVID-19 patients: inter- and intra-observer agreement in a prospective observational study"],"prefix":"10.1038","volume":"11","author":[{"given":"Markus H.","family":"Lerchbaumer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan H.","family":"Lauryn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Bachmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Enghard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Grune","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Hegemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dmytro","family":"Khadzhynov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Matthias","family":"Kruse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas J.","family":"Lehner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Lindner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timur","family":"Oezkan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Zickler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang M.","family":"Kuebler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Hamm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Uwe","family":"Eckardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Muench","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,5,21]]},"reference":[{"key":"90153_CR1","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1111\/joim.13091","volume":"288","author":"G Pascarella","year":"2020","unstructured":"Pascarella, G. et al. COVID-19 diagnosis and management: A comprehensive review. J. Intern. Med. 288, 192\u2013206 (2020).","journal-title":"J. Intern. Med."},{"key":"90153_CR2","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/S2213-2600(20)30161-2","volume":"8","author":"J Phua","year":"2020","unstructured":"Phua, J. et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir. Med. 8, 506\u2013517 (2020).","journal-title":"Lancet Respir. Med."},{"key":"90153_CR3","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1148\/radiol.2020200642","volume":"296","author":"T Ai","year":"2020","unstructured":"Ai, T. et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: A report of 1014 cases. Radiology 296, 32\u201340 (2020).","journal-title":"Radiology"},{"key":"90153_CR4","doi-asserted-by":"publisher","first-page":"101623","DOI":"10.1016\/j.tmaid.2020.101623","volume":"34","author":"AJ Rodriguez-Morales","year":"2020","unstructured":"Rodriguez-Morales, A. J. et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med. Infect. Dis. 34, 101623 (2020).","journal-title":"Travel Med. Infect. Dis."},{"issue":"16","key":"90153_CR5","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1001\/jama.2020.5394","volume":"323","author":"G Grasselli","year":"2020","unstructured":"Grasselli, G. et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 323(16), 1574\u20131581 (2020).","journal-title":"JAMA"},{"key":"90153_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2020-111426","author":"NE Okonkwo","year":"2020","unstructured":"Okonkwo, N. E. et al. COVID-19 and the US response: Accelerating health inequities. BMJ Evid.-Based Med. https:\/\/doi.org\/10.1136\/bmjebm-2020-111426 (2020).","journal-title":"BMJ Evid.-Based Med."},{"issue":"6","key":"90153_CR7","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/j.ultrasmedbio.2019.01.019","volume":"45","author":"H Shokoohi","year":"2019","unstructured":"Shokoohi, H. et al. Assessment of point-of-care ultrasound training for clinical educators in Malawi Tanzania and Uganda. Ultrasound Med Biol. 45(6), 1351\u20131357 (2019).","journal-title":"Ultrasound Med Biol."},{"issue":"1","key":"90153_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12873-015-0063-0","volume":"15","author":"P L\u00e9ger","year":"2015","unstructured":"L\u00e9ger, P. et al. A majority of rural emergency departments in the province of Quebec use point-of-care ultrasound: A cross-sectional survey. BMC Emerg. Med. 15(1), 1\u20136 (2015).","journal-title":"BMC Emerg. Med."},{"key":"90153_CR9","volume-title":"Point-of-Care Lung Ultrasound in Patients with COVID-19: A Narrative Review","author":"MJ Smith","year":"2020","unstructured":"Smith, M. J., Hayward, S. A., Innes, S. M. & Miller, A. Point-of-Care Lung Ultrasound in Patients with COVID-19: A Narrative Review (Blackwell Publishing Ltd, 2020)."},{"issue":"03","key":"90153_CR10","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1055\/a-1154-8795","volume":"41","author":"W Lu","year":"2020","unstructured":"Lu, W. et al. A clinical study of noninvasive assessment of lung lesions in patients with Coronavirus Disease-19 (COVID-19) by bedside ultrasound. Ultraschall der Medizin \u2013 Eur. J. Ultrasound. 41(03), 300\u2013307 (2020).","journal-title":"Ultraschall der Medizin \u2013 Eur. J. Ultrasound."},{"issue":"6","key":"90153_CR11","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1378\/chest.14-1313","volume":"147","author":"DA Lichtenstein","year":"2015","unstructured":"Lichtenstein, D. A. BLUE-Protocol and FALLS-Protocol: Two applications of lung ultrasound in the critically ill. Chest 147(6), 1659\u20131670 (2015).","journal-title":"Chest"},{"key":"90153_CR12","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s00134-012-2513-4","volume":"38","author":"G Volpicelli","year":"2012","unstructured":"Volpicelli, G. et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 38, 577\u2013591 (2012).","journal-title":"Intensive Care Med."},{"issue":"5","key":"90153_CR13","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1055\/s-0042-120260","volume":"38","author":"S Mongodi","year":"2017","unstructured":"Mongodi, S. et al. Modified lung ultrasound score for assessing and monitoring pulmonary aeration. Ultraschall der Medizin. 38(5), 530\u2013537 (2017).","journal-title":"Ultraschall der Medizin."},{"key":"90153_CR14","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1002\/ppul.24020","volume":"53","author":"DS Balk","year":"2018","unstructured":"Balk, D. S. et al. Lung ultrasound compared to chest X-ray for diagnosis of pediatric pneumonia: A meta-analysis. Pediatr. Pulmonol. 53, 1130\u20131139 (2018).","journal-title":"Pediatr. Pulmonol."},{"key":"90153_CR15","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1111\/echo.14664","volume":"37","author":"L Vetrugno","year":"2020","unstructured":"Vetrugno, L. et al. Our Italian experience using lung ultrasound for identification, grading and serial follow-up of severity of lung involvement for management of patients with COVID-19. Echocardiography 37, 625\u2013627 (2020).","journal-title":"Echocardiography"},{"issue":"5","key":"90153_CR16","first-page":"2776","volume":"24","author":"D Buonsenso","year":"2020","unstructured":"Buonsenso, D. et al. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: A case report and potential applications during COVID-19 outbreak. Eur. Rev. Med. Pharmacol. Sci. 24(5), 2776\u20132780 (2020).","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"90153_CR17","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1002\/jum.15285","volume":"39","author":"G Soldati","year":"2020","unstructured":"Soldati, G. et al. Proposal for international standardization of the use of lung ultrasound for patients with COVID-19: A simple, quantitative reproducible method. J. Ultrasound Med. 39, 1413\u20131419 (2020).","journal-title":"J. Ultrasound Med."},{"key":"90153_CR18","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15620","author":"A Kumar","year":"2021","unstructured":"Kumar, A. et al. Interobserver agreement of lung ultrasound findings of COVID-19. J. Ultrasound Med. https:\/\/doi.org\/10.1002\/jum.15620 (2021).","journal-title":"J. Ultrasound Med."},{"issue":"5","key":"90153_CR19","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1016\/j.ajem.2015.01.035","volume":"33","author":"P Nazerian","year":"2015","unstructured":"Nazerian, P. et al. Accuracy of lung ultrasound for the diagnosis of consolidations when compared to chest computed tomography. Am. J. Emerg. Med. 33(5), 620\u2013625 (2015).","journal-title":"Am. J. Emerg. Med."},{"issue":"1","key":"90153_CR20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/00000542-200401000-00006","volume":"100","author":"D Lichtenstein","year":"2004","unstructured":"Lichtenstein, D. et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100(1), 9\u201315 (2004).","journal-title":"Anesthesiology"},{"key":"90153_CR21","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1007\/s00441-020-03172-2","volume":"380","author":"J Grune","year":"2020","unstructured":"Grune, J., Beyhoff, N., Hegemann, N., Lauryn, J. H. & Kuebler, W. M. From bedside to bench: lung ultrasound for the assessment of pulmonary edema in animal models. Cell Tissue Res. 380, 379\u2013392 (2020).","journal-title":"Cell Tissue Res."},{"issue":"1","key":"90153_CR22","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis, J. R. & Koch, G. G. Landis amd Koch1977_agreement of categorical data. Biometrics 33(1), 159\u2013174 (1977).","journal-title":"Biometrics"},{"issue":"1","key":"90153_CR23","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.jclinepi.2010.03.002","volume":"64","author":"J Kottner","year":"2011","unstructured":"Kottner, J. et al. Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J. Clin. Epidemiol. 64(1), 96\u2013106 (2011).","journal-title":"J. Clin. Epidemiol."},{"issue":"3","key":"90153_CR24","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1148\/radiol.2020200370","volume":"295","author":"F Pan","year":"2020","unstructured":"Pan, F. et al. Time course of lung changes at chest CT during recovery from Coronavirus disease 2019 (COVID-19). Radiology 295(3), 715\u2013721 (2020).","journal-title":"Radiology"},{"key":"90153_CR25","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15580","author":"F Mento","year":"2020","unstructured":"Mento, F. et al. On the impact of different lung ultrasound imaging protocols in the evaluation of patients affected by coronavirus disease 2019. J. Ultrasound Med. https:\/\/doi.org\/10.1002\/jum.15580 (2020).","journal-title":"J. Ultrasound Med."},{"issue":"3","key":"90153_CR26","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1002\/jum.15428","volume":"40","author":"A Smargiassi","year":"2020","unstructured":"Smargiassi, A. et al. Lung ultrasound for COVID-19 patchy pneumonia: Extended or Limited Evaluations?. J. Ultrasound Med. 40(3), 521\u2013528 (2020).","journal-title":"J. Ultrasound Med."},{"issue":"11","key":"90153_CR27","doi-asserted-by":"publisher","first-page":"2927","DOI":"10.1016\/j.ultrasmedbio.2020.07.005","volume":"46","author":"N Bonadia","year":"2020","unstructured":"Bonadia, N. et al. Lung ultrasound findings are associated with mortality and need for intensive care admission in COVID-19 patients evaluated in the emergency department. Ultrasound Med. Biol. 46(11), 2927\u20132937 (2020).","journal-title":"Ultrasound Med. Biol."},{"issue":"1","key":"90153_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13089-016-0048-6","volume":"8","author":"C Mozzini","year":"2016","unstructured":"Mozzini, C., Fratta Pasini, A. M., Garbin, U. & Cominacini, L. Lung ultrasound in internal medicine: Training and clinical practice. Crit. Ultrasound J. 8(1), 1\u20137 (2016).","journal-title":"Crit. Ultrasound J."},{"issue":"6","key":"90153_CR29","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/j.jcrc.2015.08.021","volume":"30","author":"J Gullett","year":"2015","unstructured":"Gullett, J. et al. Interobserver agreement in the evaluation of B-lines using bedside ultrasound. J. Crit. Care. 30(6), 1395\u20131399 (2015).","journal-title":"J. Crit. Care."},{"issue":"3","key":"90153_CR30","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1164\/rccm.201003-0369OC","volume":"183","author":"B Bouhemad","year":"2011","unstructured":"Bouhemad, B. et al. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am. J. Respir. Crit. Care Med. 183(3), 341\u2013347 (2011).","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"90153_CR31","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1164\/rccm.201802-0227LE","volume":"198","author":"JJ Rouby","year":"2018","unstructured":"Rouby, J. J. et al. Training for lung ultrasound score measurement in critically ill patients. Am. J. Respir. Crit. Care Med. 198, 398\u2013401. https:\/\/doi.org\/10.1164\/rccm.201802-0227LE (2018).","journal-title":"Am. J. Respir. Crit. Care Med."},{"issue":"11","key":"90153_CR32","doi-asserted-by":"publisher","first-page":"2312","DOI":"10.1109\/TUFFC.2020.3002249","volume":"67","author":"C Baloescu","year":"2020","unstructured":"Baloescu, C. et al. Automated Lung Ultrasound B-line assessment using a deep learning algorithm. IEEE Trans. Ultrason. Ferroelectr. Freq. Control 67(11), 2312\u20132320 (2020).","journal-title":"IEEE Trans. Ultrason. Ferroelectr. Freq. Control"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90153-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90153-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90153-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T03:36:44Z","timestamp":1670038604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90153-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,21]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["90153"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-90153-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,21]]},"assertion":[{"value":"17 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10678"}}