SESSION TYPE: Imaging Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Acute dyspnea is a common symptom encountered by internal medicine house staff. It is traditionally assessed with the use of history, physical examination, chest x-ray, EKG and labs.Lung ultrasound is a rapid, non-invasive method which has been shown to be more sensitive and specific than chest radiograph for conditions causing dyspnea and is thus increasingly used to evaluate acute respiratory conditions (1) With lung ultrasound there is no time delay, which is inherent to standard radiographic techniques, and the physician applies the results with clinical knowledge of the patient (2). Our study assesses the capacity of medical residents to learn lung ultrasonography with minimal training and to apply these principles in the evaluation of acute dyspnea. .
METHODS: Six internal medicine residents completed a focused 1 hour training program and a training portfolio. This involved image documentation of 5 standardized images of A-line, B-lines, lung sliding, and pleural effusions using hand-carried lung ultrasounds. Residents performed lung ultrasounds on patients who were admitted to the MICU with acute dyspnea or developed unexplained acute dyspnea while in the MICU, were supervised by a principal investigator, and submitted interpretations using a standardized report form.
RESULTS: Internal Medicine house staff with limited training were able to identify 71.05% of A-lines, 83.33% of B-lines and 89.47% of lung sliding. In 94.73% of patients, lung ultrasound corroborated the clinical diagnosis. When the clinical impression changed after lung ultrasound it was due to a finding of a pleural effusion not seen on chest x-ray. The concordance of chest x-rays with lung ultrasounds was 63.15%
CONCLUSIONS: Internal medicine house staff with limited training were able to obtain findings concordant with a principal investigator’s findings. Lung ultrasounds were highly concordant with clinical diagnosis among ICU patients with dyspnea, and in one case it was more accurate suggesting that ultrasound could replace more time-consuming and radiation-inducing radiography in patients with acute dyspnea. The less than expected concordance of chest x-rays with lung ultrasounds could be due to the non-specific findings reported by radiologists.
CLINICAL IMPLICATIONS: With limited training, Internal Medicine house staff is able to obtain skills to perform lung ultrasonography to augment their physical exam findings, this can lead to higher diagnostic accuracy without the need for ancillary testing.
DISCLOSURE: The following authors have nothing to disclose: Patricia Centron, Marcos Hernandez, Ravindra Rajmane
No Product/Research Disclosure InformationNew York Downtown Hospital, New York, NY