Assessment of an Ultrasonography-Based Algorithm for Detecting the Causes of Acute Dyspnea in an Emergency Hospital.

OBJECTIVE

To investigate the value of point-of-care ultrasonography (POCUS) in identifying the causes of acute dyspnea (AD).

METHODS

In this prospective study, hospitalized adults with AD were enrolled. They underwent POCUS of the heart, lungs, and deep veins of the lower extremities, supplemented by lung auscultation (LA); all examinations were performed by an investigator blinded to the clinical diagnosis. The ultrasound profiles were compared with the clinical diagnoses to determine the diagnostic accuracy of the method.

RESULTS

A total of 150 patients, with a mean age of 65.8±15.7 years, were enrolled, and 53% were women. POCUS combined with LA showed a higher diagnostic accuracy [0.86 (95% confidence interval (CI), 0.81-0.91)] than POCUS alone [0.78 (95% CI, 0.72-0.84)]. The POCUS-based protocol showed the highest sensitivity for pleural effusion (1.0) and pericardial effusion [0.94 (95% CI, 0.81-1.00)], and the lowest sensitivity for pneumothorax (0.75 [95% CI, 0.20-1.00]) and pulmonary edema [0.78 (95% CI, 0.69-0.87)]. The examination duration was 12.5±3.9 min.

CONCLUSIONS

The POCUS-based protocol was a rapid, informative tool for identifying the causes of AD in hospitalized adults, and the addition of LA further increased its diagnostic accuracy.