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European SARS-CoV-2 pandemic epicenter was detected in Northern Italy, in a little Italian town of Lodi province, the Lodi Hospital was therefore rapidly saturated, and in particularly the departments of respiratory diseases and Intensive Care Unit had been largely involved. In this paper, we describe how the first Sub-intensive Respiratory Unit in Europe completely dedicated to COVID-19 patients was organized and managed in our hospital. From February 25th to April 30th 2020, 156 patients were admitted to our Respiratory Sub-intensive Unit. Among them, 100 were discharged, 28 dead and 28 transferred to ICU for intubation.

Introduction: Non-cardiac chest pain represents a diagnostic challenge, as it is a common symptom of a broad spectrum of diseases. The present study focuses on infectious diseases, testing the accuracy of lung ultrasound in detecting community acquired pneumonia (CAP) in patients with pleuritic pain. Methods: Consecutive patients admitted to the emergency department or respiratory unit with pleuritic pain underwent lung ultrasound with a standardized protocol and chest X-ray in two projections in the upright position. Final diagnosis was established by an independent committee. Results: 132 patients (70 females, 52%) aged 54±19 yrs, BMI of 23.8 ± 5.1 kg/m2(mean±SD), were enrolled. 131 patients underwent chest X-ray (one patient was pregnant). In all patients lung ultrasound was performed. The duration of the exam was 5±2 minutes. 38 patients (29%) underwent computed tomography for clinical reasons. Final diagnoses were: 62 CAP (47%), 51 chest pain (39%), 7 lung tumors (5%), 5 pleuritis (4%), 3 pneumothorax (2%), 4 miscellaneous (3%). Sensitivity and specificity of chest X-ray in CAP diagnosis were, respectively, 86.5% (IC 95%, 76.9%-92.5%) and 89.5% (IC 95%, 78.9%-95.1%). Sensitivity and specificity of lung ultrasound were 93.5% (IC 95%, 85.7%-97.2%) and 96.4% (IC 95%, 87.7%-99%) respectively. Positive predictive values of RX and lung ultrasound were, respectively, 91.4% (IC 95%, 84.9%-98.0%) and 97.3% (IC 95%, 93.6%-100%); negative predictive values were 83.6% (IC 95%, 74.3%-92.9%) and 91.4% (IC 95%, 84.2%-98.6%). Conclusions: Preliminary data suggest that ultrasound is an accurate diagnostic technique for CAP diagnosis in patients with pleuritic chest pain (clinicaltrial.gov [NCT02107001][1]). [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT02107001&atom=%2Ferj%2F46%2Fsuppl_59%2FOA496.atom