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{
    "pk": 9322,
    "title": "Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea",
    "subtitle": null,
    "abstract": "Introduction:\n Determining the etiology of acute dyspnea in emregency department (ED) patients is often difficult. Point-of-care ultrasound (POCUS) holds promise for improving immediate diagnostic accuracy (after history and physical), thus improving use of focused therapies. We evaluate the impact of a three-part POCUS exam, or “triple scan” (TS) – composed of abbreviated echocardiography, lung ultrasound and inferior vena cava (IVC) collapsibility assessment – on the treating physician’s immediate diagnostic impression.\nMethods:\n A convenience sample of adults presenting to our urban academic ED with acute dyspnea (Emergency Severity Index 1, 2) were prospectively enrolled when investigator sonographers were available. The method for performing components of the TS has been previously described in detail. Treating physicians rated the most likely diagnosis after history and physical but before other studies (except electrocardiogram) returned. An investigator then performed TS and disclosed the results, after which most likely diagnosis was reassessed. Final diagnosis (criterion standard) was based on medical record review by expert emergency medicine faculty blinded to TS result. We compared accuracy of pre-TS and post-TS impression (primary outcome) with McNemar’s test. Test characteristics for treating physician impression were also calculated by dichotomizing acute decompensated heart failure (ADHF), chronic obstructive pulmonary disease (COPD) and pneumonia as present or absent.\nResults:\n 57 patients were enrolled with the leading final diagnoses being ADHF (26%), COPD/asthma (30%), and pneumonia (28%). Overall accuracy of the treating physician’s impression increased from 53% before TS to 77% after TS (p=0.003). The post-TS impression was 100% sensitive and 84% specific for ADHF.\nConclusion:\n In this small study, POCUS evaluation of the heart, lungs and IVC improved the treating physician’s immediate overall diagnostic accuracy for ADHF, COPD/asthma and pneumonia and was particularly useful to immediately exclude ADHF as the cause of acute dyspnea.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "ultrasound"
        },
        {
            "word": "Dyspnea"
        }
    ],
    "section": "Technology in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/69d904q7",
    "frozenauthors": [
        {
            "first_name": "Daniel",
            "middle_name": "",
            "last_name": "Mantuani",
            "name_suffix": "",
            "institution": "Alameda Health System Highland Campus, Department of Emergency Medicine, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "Bradley",
            "middle_name": "W.",
            "last_name": "Frazee",
            "name_suffix": "",
            "institution": "Alameda Health System Highland Campus, Department of Emergency Medicine, Oakland, California",
            "department": "None"
        },
        {
            "first_name": "Jahan",
            "middle_name": "",
            "last_name": "Fahimi",
            "name_suffix": "",
            "institution": "University of California San Francisco, Department of Emergency Medicine, San Francisco, California",
            "department": "None"
        },
        {
            "first_name": "Arun",
            "middle_name": "",
            "last_name": "Nagdev",
            "name_suffix": "",
            "institution": "Alameda Health System Highland Campus, Department of Emergency Medicine, Oakland, California",
            "department": "None"
        }
    ],
    "date_submitted": "2015-08-27T23:04:48Z",
    "date_accepted": "2015-08-27T23:04:48Z",
    "date_published": "2016-01-13T00:21:32Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9322/galley/5253/download/"
        }
    ]
}