Assessment of the shortened and expanded focused ultrasonography algorithms for identifying the causes of acute shortness of breath in a multidisciplinary emergency hospital

Abstract

Objective. To investigate the value of the shortened (SUS) and expanded (EUS) focused ultrasonography (FoCUS) algorithms in identifying the causes of acute dyspnea (AD) in a multidisciplinary emergency hospital.

Material and methods. In this prospective study hospitalized adults with AD were enrolled. They underwent FoCUS of the heart, lungs, and deep veins of the lower extremities with application SUS and EUS, supplemented with lung auscultation (LA). The ultrasound profiles were compared with the clinical diagnoses to determine the diagnostic accuracy of the both algorithms with time registration.

Results. A total of 150 patients, mean age 65.8±15.7 years, 53% females, were enrolled. The most frequent causes of AD were worsening of chronic heart failure, pulmonary embolism (PE) and pneumonia. Comparative analysis demonstrated advantages of EUS supplemented with LA in identifying the causes of AD vs SUS: diagnostic accuracy was 0.83 [95% confidence interval (CI) 0.77–0.89] and 0.79 [95% CI 0.73–0.85], respectively. The diagnostic accuracy EUS and SUS was the highest for pleural, pericardial effusion and pneumonia (sensitivity/specificity 1.0/1.0; 0.94/1.0; 0.89/0.97, respectively) and slightly lower for pulmonary edema and pneumothorax (sensitivity/specificity 0.78/1.0; 0.75/1.0, respectively). In cases of PE EUS algorithm demonstrated greater sensitivity 0.79 [95% CI 0.62–0.95] as compared to SUS 0.46 [95% CI 0.26–0.68]. Both algorithms supplemented with LA have sensitivity and specificity equal 1,0 for broncho-obstructive syndrome. The median of the examination amounted to EUS – 12 (10; 15), SUS – 11 (9; 14) minutes, p<0.001.

Conclusion. The EUS algorithm supplemented with LA demonstrates better diagnostic accuracy vs SUS in identifying the main causes of AD without a clinically significant increase in examination time.