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Original Research: Pulmonary Procedures |

Focused Sonography of the Heart, Lungs, and Deep Veins Identifies Missed Life-Threatening Conditions in Admitted Patients With Acute Respiratory SymptomsSonography Identifies Life-Threatening Conditions

Christian B. Laursen, MD; Erik Sloth, MD, DrMedSc, PhD; Jess Lambrechtsen, MD, PhD; Annmarie Touborg Lassen, MD, DrMedSc, PhD; Poul Henning Madsen, MD; Daniel Pilsgaard Henriksen, MD; Jesper Rømhild Davidsen, MD, PhD; Finn Rasmussen, MD, DrMedSc, PhD
Author and Funding Information

From the Research Unit at the Department of Respiratory Medicine (Dr Laursen), the Department of Emergency Medicine (Drs Lassen and Henriksen), and the Department of Respiratory Medicine (Dr Davidsen), Odense University Hospital; and the Institute of Clinical Research (Drs Laursen and Henriksen), University of Southern Denmark, Odense, Denmark; the Department of Anesthesia and Intensive Care (Dr Sloth), Aarhus University Hospital, Skejby, Denmark; the Department of Medicine (Dr Lambrechtsen), Odense University Hospital—Svendborg, Svendborg, Denmark; the Department of Medicine (Dr Madsen), Littlebelt Hospital, Fredericia, Denmark; and the Department of Allergy and Respiratory Medicine (Dr Rasmussen), Near East University Hospital, Nicosia, North Cyprus, Turkey.

Correspondence to: Christian B. Laursen, MD, Research Unit at the Department of Respiratory Medicine, Odense University Hospital, Sdr. Blvd 29, 5000 Odense C, Denmark; e-mail: fissirul_lohmand@hotmail.com


Part of the study has previously been published and presented as an abstract and oral presentation at the Danish Emergency Medicine Conference in 2011 (Laursen CB, Sloth E, Lambrechtsen J, Lassen AT, Rasmussen F. Scand J Trauma Resusc Emerg Med. 2012;20[suppl 2]:22) and as an oral abstract presentation at the European Association of Cardiothoracic Anaesthesiologists Annual Meeting in 2012 (Laursen CB, Jakobsen C, Lassen AT, Lambrechtsen J, Rasmussen F, Sloth E. Appl Cardiopulm Pathophysiol. 2012;16[suppl 1]:187).

Funding/Support: The study was funded as a part of the corresponding author’s PhD study. The funding was provided by The Højbjerg Fund; the Research Unit at the Department of Respiratory Medicine, Odense University Hospital, Denmark; the Research Council at Odense University Hospital, Denmark; and the University of Southern Denmark, Denmark.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1868-1875. doi:10.1378/chest.13-0882
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Background:  Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute respiratory symptoms.

Methods:  A prospective blinded observational study was conducted in a medical ED. Inclusion criteria were the presence of one or more of the following: respiratory rate > 20/min, oxygen saturation < 95%, oxygen therapy initiated, dyspnea, cough, or chest pain. After the initial assessment, focused sonography of the heart, lungs, and deep veins was performed by a physician blinded to patient history and the results of the primary assessment.

Results:  One hundred thirty-nine patients were included. The focused sonographic examinations could be performed in 134 patients (96%). Focused sonography identified 19 patients (14%) with an acute life-threatening condition missed at the primary assessment. Diagnostic performance of focused sonography for the diagnosis of an acute life-threatening condition, when using audit as gold standard, was as follows: sensitivity, 100% (95% CI, 85.2%-100%); specificity, 93.3% (95% CI, 86.7%-97.3%); positive predictive value, 76.7% (95% CI, 57.7%-90.1%); and negative predictive value, 100% (95% CI, 96.3%-100%).

Conclusions:  Focused sonography of the heart, lungs, and deep veins is fast, highly feasible, and able to diagnose life-threatening conditions missed at the primary assessment in admitted patients with acute respiratory symptoms. In an ED setting sonography can be used both for ruling in and ruling out acute life-threatening conditions in these patients.

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