PURPOSE: Acute life-threatening dyspnea is a common challenge that physicians encounter. Rapid diagnostic bedside tests to aid clinical impressions are needed. Ultrasonography has assisted clinicians in various critical care settings. The purpose of this study was to assess the utility of an ultrasound-based algorithm during rapid response team(RRT) evaluations of acute life-threatening dyspnea.
METHODS: The study took place over six months starting July 1, 2006 in an urban hospital with a RRT led by internal medicine residents and pulmonary/critical care fellows. During a rapid response called for dyspnea, the RRT leader assessed the patient and was asked to give a pre-ultrasound physician diagnosis. Using an ultrasound-based algorithm, non RRT pulmonary/critical care fellows trained in lung, vascular, and cardiac ultrasonography, performed a directed ultrasound examination . Ultrasonography specifically evaluated for sliding lung, B lines, consolidation pattern, pleural effusions, deep vein thrombosis, and estimation of ejection fraction. An ultrasound diagnosis was formulated from the following possibilities: acute cardiogenic pulmonary edema, Chronic Obstructive Pulmonary Disease exacerbation/Asthma exacerbation, pneumonia, Acute Respiratory Distress Syndrome/noncardiogenic pulmonary edema, and pulmonary embolus. Pre-ultrasound physician diagnoses and ultrasound diagnoses were compared to each other and to the final diagnoses.
RESULTS: The study enrolled 12 patients. Pre-ultrasound physician diagnoses were in concordance with final diagnoses in 6/12 (50%) cases. Ultrasound diagnoses were in concordance with final diagnoses in 8/12 (66%) cases. Pre-ultrasound physician diagnoses and ultrasound diagnoses agreed 4/12 (30%) of time. In 4/12 (30%) cases ultrasound would have correctly changed management, but incorrectly changed management in 2/12 (16%) cases. In 2/12 (16%) cases, pre-ultrasound physician diagnoses and ultrasound diagnoses were incorrect. Time for ultrasound diagnoses ranged from 60–270 seconds.
CONCLUSION: An ultrasound dyspnea algorithm can rapidly modify initial bedside clinical diagnosis. These changes appear to be more often correct than incorrect.
CLINICAL IMPLICATIONS: Ultrasonography may aid clinicians in quickly diagnosing and treating acute dyspnea.
DISCLOSURE: Eli Gavi, No Financial Disclosure Information; No Product/Research Disclosure Information