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Intensive Care Medicine

, Volume 39, Issue 7, pp 1290–1298 | Cite as

Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

  • G. VolpicelliEmail author
  • A. Lamorte
  • M. Tullio
  • L. Cardinale
  • M. Giraudo
  • V. Stefanone
  • E. Boero
  • P. Nazerian
  • R. Pozzi
  • M. F. Frascisco
Original

Abstract

Purpose

We analyzed the efficacy of a point-of-care ultrasonographic protocol, based on a focused multiorgan examination, for the diagnostic process of symptomatic, non-traumatic hypotensive patients in the emergency department.

Methods

We prospectively enrolled 108 adult patients complaining of non-traumatic symptomatic hypotension of uncertain etiology. Patients received immediate point-of-care ultrasonography to determine cardiac function and right/left ventricle diameter rate, inferior vena cava diameter and collapsibility, pulmonary congestion, consolidations and sliding, abdominal free fluid and aortic aneurysm, and leg vein thrombosis. The organ-oriented diagnoses were combined to formulate an ultrasonographic hypothesis of the cause of hemodynamic instability. The ultrasonographic diagnosis was then compared with a final clinical diagnosis obtained by agreement of three independent expert physicians who performed a retrospective hospital chart review of each case.

Results

Considering the whole population, concordance between the point-of-care ultrasonography diagnosis and the final clinical diagnosis was interpreted as good, with Cohen’s k = 0.710 (95 % CI, 0.614–0.806), p < 0.0001 and raw agreement (Ra) = 0.768. By eliminating the 13 cases where the final clinical diagnosis was not agreed upon (indefinite), the concordance increased to almost perfect, with k = 0.971 (95 % CI, 0.932–1.000), p < 0.0001 and Ra = 0.978.

Conclusions

Emergency diagnostic judgments guided by point-of-care multiorgan ultrasonography in patients presenting with undifferentiated hypotension significantly agreed with a final clinical diagnosis obtained by retrospective chart review. The integration of an ultrasonographic multiorgan protocol in the diagnostic process of undifferentiated hypotension has great potential in guiding the first-line therapeutic approach.

Keywords

Hypotension Shock Ultrasonography Diagnosis 

Notes

Acknowledgments

The authors thank all the staff of our emergency department who worked with enthusiasm in the study.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • G. Volpicelli
    • 1
    Email author
  • A. Lamorte
    • 1
  • M. Tullio
    • 1
  • L. Cardinale
    • 2
  • M. Giraudo
    • 3
  • V. Stefanone
    • 1
  • E. Boero
    • 1
  • P. Nazerian
    • 4
  • R. Pozzi
    • 5
  • M. F. Frascisco
    • 1
  1. 1.Department of Emergency Medicine, S.C.D.O, Medicina d’UrgenzaOspedale Universitario San Luigi GonzagaTurinItaly
  2. 2.Radiology DepartmentSan Luigi Gonzaga University HospitalTurinItaly
  3. 3.Department of MathematicsUniversity of TorinoTurinItaly
  4. 4.Department of Emergency MedicineCareggi University HospitalFlorenceItaly
  5. 5.Cardiology UnitSan Luigi Gonzaga University HospitalTurinItaly

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