DIAGNOSTIC ACCURACY OF POINT OF CARE ULTRASOUND IN ADULT PATIENTS PRESENTING WITH ACUTE DYSPNEA TO EMERGENCY DEPARTMENT
Main Article Content
Keywords
Acute Dyspnea, Point of Care Ultrasound, Diagnostic Accuracy
Abstract
Background
Lung ultrasonography as a diagnostic tool in various specialized and clinical contexts are all becoming more and more supported by data. Emergency physicians are actively researching and implementing focused multidimensional ultrasound as a mode of care technique because of the urgent requirement for diagnosis in the ED. However, research from local settings are scarce.
Objective
To ascertain the diagnostic accuracy of POCUS in identifying the different causes of sudden onset dyspnea taking final clinical diagnosis as gold standard.
Materials and Methods
A total of 219 male and female patients aging 20 to 60 years presenting with acute shortness of breath were enrolled at the department of emergency medicine, CMH Rawalpindi during the period 15th April 2022 till 14th April 2024. A point of care ultrasound was performed and findings were compared with final clinical diagnosis by emergency specialist. 2x2 table was used to draw the diagnostic accuracy.
Results
Mean age of the participants was 35.44±10.887 years with majority of the patient in the age group less than 40 years (n = 161, 73.5%) while male participants were 138 (63.0%), MRC grade 5 dyspnea was more common (n = 127, 58.0%). The sensitivity of POCUS for pneumonia was 23.5% and specificity was 76.7%. The kappa value for agreement was 0.027. The sensitivity of POCUS for pulmonary edema was 10.2%, specificity was 89.4% and kappa value was 0.004.
Conclusion
PoCUS exhibits considerable screening potential for various clinical conditions presenting with acute shortness of breath. It enables swift interpretations by integrating its comprehensive reliability, agreement with the ultimate composite diagnosis.
References
2. Kelly AM, Keijzers G, Klim S, Graham CA, Craig S, Kuan WS, et al. An Observational study of dyspnea in emergency departments: the Asia, Australia, and New Zealand Dyspnea in Emergency Departments Study (AANZDEM) Acad Emerg Med. 2017;24(3):328–336.
3. Mockel M, Searle J, Muller R, Slagman A, Storchmann H, Oestereich P, et al. Chief complaints in medical emergencies. Eur J Emerg Med. 2013;20(2):103–108.
4. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010;26:1–31.
5. Ray P, Birolleau S, Lefort Y, Becquemin MH, Beigelman C, Isnard R, et al. Acute respiratory failure in the elderly: Etiology, emergency diagnosis and prognosis. Crit Care. 2006;10(3):1–12.
6. Berliner D, Schneider N, Welte T, Bauersachs J. The differential diagnosis of dyspnoea. Dtsch Arztebl Int. 2016;113(49):834–845.
7. Goldberg BB, Gramiak R, Freimanis AK. Early history of diagnostic ultrasound: the role of American radiologists. AJR Am J Roentgenol. 1993;160(1):189–194.
8. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117–125.
9. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH Exam: Rapid Ultrasound in SHock in the Evaluation of the Critically lll. Emerg Med Clin North Am. 2010;28(1):29–56.
10. Lichtenstein D. FALLS-protocol: lung ultrasound in hemodynamic assessment of shock. Hear Lung Vessel. 2013;5(3):142–147.
11. Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO. Bedside echocardiography by emergency physicians. Ann Emerg Med. 2001;38(4):377–382.
12. Zanobetti M, Scorpiniti M, Gigli C, Nazerian P, Vanni S, Innocenti F, et al. Point-of-Care Ultrasonography for evaluation of acute dyspnea in the ED. Chest. 2017;151(6):1295–1301.
13. Buhumaid RE, St-Cyr Bourque J, Shokoohi H, Ma IWY, Longacre M, Liteplo AS. Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. Am J Emerg Med. 2019;37(2):298–303.
14. Guttikonda SNR, Vadapalli K. Approach to undifferentiated dyspnea in emergency department: aids in rapid clinical decision-making. Int J Emerg Med. 2018;11(1):21.
15. Baid H, Vempalli N, Kumar S, Arora P, Walia R, Chauhan U, et al. Point of care ultrasound as initial diagnostic tool in acute dyspnea patients in the emergency department of a tertiary care center: diagnostic accuracy study. Int J Emerg Med. 2022 Jun 13;15(1):27.
16. Russell FM, Ehrman RR, Cosby K, Ansari A, Tseeng S, Christain E, et al. Diagnosing acute heart failure in patients with undifferentiated dyspnea: a lung and cardiac ultrasound (LuCUS) protocol. Acad Emerg Med. 2015;22(2):182–191.
17. Wang Y, Shen Z, Lu X, Zhen Y, Li H. Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis. Med Ultrason. 2018;1(1):32–36.
18. Hansell L, Milross M, Delaney A, Tian DH, Ntoumenopoulos G. Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review. J Physiother. 2021;67(1):41–48.