Immediate versus delayed integrated point-of-care-ultrasonography to manage acute dyspnea in the emergency departmentReportar como inadecuado




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Critical Ultrasound Journal

, 6:5

First Online: 27 April 2014Received: 14 July 2013Accepted: 08 April 2014

Abstract

BackgroundDyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ultrasound should help to differentiate cardiogenic from non-cardiogenic causes of dyspnea. We evaluated whether the diagnostic accuracy can be improved by adding a point-of-care-ultrasonography POC-US to routine exams and if an early use of this technique produces any advantage.

MethodsOne hundred sixty-eight patients were enrolled and randomized in two groups: Group 1 received an immediate POC-US in addition to routine laboratory and instrumental tests; group 2 received an ultrasound scan within 1 h from the admission to the Emergency Department. The concordance between initial and final diagnosis and the percentage of wrong diagnosis in the two groups were evaluated. Mortality, days of hospitalization in Emergency Medicine department and transfers to other wards were compared. Sensitivity and specificity of the routine protocol and the one including ultrasonography for the diagnosis of the causes of dyspnea were also analyzed.

ResultsEighty-eight patients were randomized in group 1 and 80 in group 2. The concordance rate between initial and final diagnoses was significantly different 0.94 in group 1 vs. 0.22 in group 2, p < 0.005. The percentage of wrong initial diagnosis was 5% in group 1 and 50% in group 2 p < 0.0001.

ConclusionsAdding POC-US to routine exams improves the diagnostic accuracy of dyspnea and reduces errors in the Emergency Department.

KeywordsPoint-of-care-ultrasonography Dyspnea Diagnostic accuracy Emergency Department AbbreviationsABGarterial blood gases

AHFacute heart failure

AP4apical 4 chamber

ARDSacute respiratory distress syndrome

CUScompressive ultrasonography

CXRchest x-ray

ECGelectrocardiography

ECOPDexacerbation of chronic obstructive pulmonary disease

EDEmergency Department

EPemergency physician

IVCinferior vena cava

LVleft ventricle

POC-USpoint-of-care ultrasound

RVright ventricle

SCsubcostal.

Electronic supplementary materialThe online version of this article doi:10.1186-2036-7902-6-5 contains supplementary material, which is available to authorized users.

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Autor: Concetta Pirozzi - Fabio G Numis - Antonio Pagano - Paolo Melillo - Roberto Copetti - Fernando Schiraldi

Fuente: https://link.springer.com/







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