Dyspnoea is a common presenting complaint in the Emergency Department (ED). Dyspnoea
requires timely evaluation and treatment as several conditions causing dyspnea are time
critical.
Previous studies have suggested that point-of-care ultrasound (POCUS) increase diagnostic
accuracy in the initial assessment of patients with dyspnoea. However, in most studies
POCUS was done by highly experienced physicians which could limit the generalisability of
POCUS in the hands of all emergency specialist and residents.
Aim To evaluate whether POCUS performed by a variety of emergency medicine physicians
(specialists and residents) increase diagnostic accuracy in patients with dyspnea
compared to routine assessment.
Method:
Specialist and residents in Emergency Medicine at the ED in Lund and Helsingborg (Sweden)
will have a short training and certification in a structured dyspnea POCUS protocol. The
protocol includes focused lung (8 or 14 zones), heart (subcostal, parasternal and apical
four chamber views) and inferior vena cava ultrasound.
Study design Prospective observational study
Study population
Inclusion criteria
Adult patients presenting to the Emergency Department within the highest or second
highest triage category (Rapid Emergency Triage and Treatment System) and any of the
following:
Presenting with shortness of breath
Oxygen saturation less than 90 % on room air
Respiratory rate more than 25 breaths per minute and oxygen saturation less than 95
% on room air
Exclusion criteria
Patients will be included when a physician certified in the dyspnea POUCUS protocol is
present in the ED (convenience sample) Firstly, an ED physician will assess the patient
using available routine diagnostic procedures. After consent to the study, the physician
will document the estimated likelihood (not likely, unlikely, likely, very likely) of the
following diagnosis: heart failure, pulmonary embolism, pneumonia, exacerbation of
chronic obstructive pulmonary disease (COPD), exacerbation of asthma, pleural or
pericardial fluid. Clinical bedside tests will be available as in routine practice in the
ED (e.g., ecg, blood gas results). A physician certified in the dyspnea protocol will
then perform POCUS and deliver the findings to the initial physician assessing the
patients. Hereafter, the initial physician documents the estimated likelihood of the
above diagnosis being provided the ultrasound findings.
The estimated likelihoods (before and after POCUS) will be dichotomised and compared to
the discharge diagnosis. Sensitivity, specificity, negative and positive predictive
values of the diagnostic accuracy before and after adding POCUS will be calculated.
In addition to routine bed-side tests alle included patients will have the following
ordered: chest imaging (x-ray or CT according to ED physicians' choice), N-terminal
pro-B-type natriuretic peptide (pro-BNP), C-reactive protein and white blood count.