Background
Acute dyspnea is a common symptom in the emergency department and several studies have investigated the usefulness of Lung Ultrasound (LUS) in the approach to the patient with dyspnea with different results.
Objective
On the basis of the literature, we performed a prospective observational study, aiming to assess the accuracy of LUS for the diagnosis of cardiogenic dyspnea in patients presenting at the emergency department with acute dyspnea.
Patients and methods
70 patients presenting with acute dyspnea have been enrolled.
On admission every patient underwent to LUS and chest X-ray (CXR). Ultrasound findings of Interstitial Alveolar Syndrome (IAS), which correlate with an increase in interstitial lung water, were reported. On the results of LUS, the patients were attributed to 2 different diagnostic groups: Group 1: patients with cardiogenic dyspnea, Group 2: patients with respiratory dyspnea. CXR was performed as gold standard exam to discriminate the respiratory and cardiogenic origin of the dyspnea. At the discharge from the hospital, two investigators blind to the results of the LUS exam, revised all the clinical charts and attributedevery patient to a definitive diagnostic group. On the basis of the results, it was possible to calculate Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value of LUS and CXR for the diagnosis of cardiogenic dyspnea.
Results
LUS showed a sensitivity of 92%, Specificity 93%, PPV 88%, NPV 95%; while CXR showed Sensitivity 79%, Specificity 74%, PPV 61%, NPV 87%. Differences between Specificity and PPV were significant (Chi-Square test, P<0.05).
Conclusion
LUS can be more effective than CXR for the diagnosis of cardiogenic dyspnea.
References
Cibinel GA, Casoli G, Elia F, et al.: Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department. Intern Emerg Med 2012,7(1):65–70. 10.1007/s11739-011-0709-1
Volpicelli G, Elbarbary M, et al.: International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012, 38: 577–591. 10.1007/s00134-012-2513-4
Zanobetti M, Poggioni C, Pini R: Can chest ultrasonography replace standard chest radiography for evaluation of acute dyspnea in the ED? Chest 2011, 139: 1140–1147. 10.1378/chest.10-0435
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Spinelli, A., De Curtis, E., Savino, A. et al. Acute cardiogenic dyspnea in the emergency department: accuracy of lung ultrasound. Crit Ultrasound J 6 (Suppl 2), A7 (2014). https://doi.org/10.1186/2036-7902-6-S2-A7
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DOI: https://doi.org/10.1186/2036-7902-6-S2-A7