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Original Research |

Point-of-care ultrasonography for evaluation of acute dyspnea in the emergency department

Maurizio Zanobetti, M.D; Margherita Scorpiniti, M.D.; Chiara Gigli, M.D.; Peiman Nazerian, M.D.; Simone Vanni, M.D.; Francesca Innocenti, M.D.; Valerio T. Stefanone, M.D.; Caterina Savinelli, M.D.; Alessandro Coppa, M.D.; Sofia Bigiarini, M.D.; Francesca Caldi, M.D.; Irene Tassinari, M.D.; Alberto Conti, M.D.; Stefano Grifoni, M.D.; Riccardo Pini, M.D.
Author and Funding Information

No potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Emergency Department, Careggi University Hospital, Florence, Italy

Corresponding author informations Maurizio Zanobetti, Largo Brambilla 3, 50134 Firenze.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.02.003
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Abstract

Background  Acute dyspnea is a common symptom in the emergency department (ED). Standard approach to dyspnea often relies on radiologic and laboratoristic results, causing excessive delay before adequate therapy is started; an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis maintaining an acceptable safety profile.

Methods  Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled. The gold standard was the final diagnosis assessed by two expert reviewers. Two physicians independently evaluated the patient: sonographer performed ultrasonography (US) evaluation of lung, heart and inferior vena cava, while treating physician requested traditional tests as needed. Time needed to formulate US and ED diagnosis was recorded and compared. Accuracy and concordance of US and ED diagnosis were calculated.

Results  2683 patients were enrolled. Average time needed to formulate US diagnosis was significantly lower than that required for ED diagnosis (24±10 min vs 186±72 min, p 0.025). US and ED diagnosis showed a good overall concordance (k=0.71). There were no statistically significant differences in the accuracy of PoCUS and standard ED workup for the diagnosis of acute coronary syndrome, pneumonia, pleural effusion, pericardial effusion, pneumothorax and dyspnea from other causes; PoCUS was significantly more sensitive for the diagnosis of heart failure, while standard ED workup performed better in the diagnosis of chronic obstructive pulmonary disease/asthma and pulmonary embolism.

Conclusions  PoCUS represents a feasible and reliable diagnostic approach to the dyspnoic patient, allowing a reduction of the diagnostic time. This protocol could help to stratify patients who should undergo a more detailed evaluation.


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