Abstract
BackgroundA fast and diagnostic accurate tool to assess the unselected category of high-acuity patients, in whom the underlying pathology is not always obvious, is needed in the emergency departments (ED). We aim to describe the feasibility, validity and diagnostic yield of a routine whole-body-focused ultrasonography (wbf-us) in an unselected group of high-acuity ED patients.MethodsIn a prospective observational study, a convenience sample of ED patients (≥ 18 years) with a high-acuity score or systolic blood pressure < 100 mmHg received a routine wbf-us of the heart, lungs, abdomen and deep veins by two non-expert sonographers. Final diagnosis was established by experienced auditors. Investigators were blinded to the patients’ medical history and emergency physicians and auditors were blinded to the investigators assessments. Diagnostic accuracy was assessed by comparing the investigators’ ultrasonography findings to a structured double-blinded clinical audit of patient files.ResultsWe included 171 patients, initiated a whole-body-focused ultrasonography examination (wbf-us) in 160 and completed it in 128 patients with an average time of a full examination of 28 min. We found pathology in 65/171 (38%) of the patients whose most frequent symptoms upon arrival were cardiopulmonary. Among the patients who received wbf-us, we found the majority of pathology by wbf-us of the lungs (n = 50, 31%), the heart (n = 26, 16%), few in the abdomen (n = 5, 3%) and none in the deep veins. The overall sensitivity was 50–100%, specificity 84–94%, positive predictive value 11–44% and negative predictive value 94–100%.ConclusionFocused cardiopulmonary ultrasonography might be considered for routine use in high-acuity ED patients with cardiopulmonary symptoms whereas focused ultrasonography of the abdomen and deep veins performed by non-expert sonographers only seems indicated in selected patients.Trial registration Danish Data Protection Agency (ID 13/12076). Committee on Biomedical Research Ethics for the Region of Southern Denmark (ID S-20130047).
Highlights
Rapid and accurate identification of the cause for severe illness in unselected high-acuity patients is often a challenge to the emergency physician (EP) [1, 2].Focused ultrasonography (f-us) is a noninvasive bedside tool, generally free of pain and ionizing radiation, fairly easy to learn and associated with a reduction in the use of more cumbersome imaging [3,4,5]
We looked for signs of a deep-vein thrombosis (DVT)
With the wbf-us we found one or more pathologies in 65/171 (38%) patients allocated to the departments as follows: Medical Department 58/147 (39%); Surgical Departments 4/17 (24%) and from other departments 3/7 (43%)
Summary
Rapid and accurate identification of the cause for severe illness in unselected high-acuity patients is often a challenge to the emergency physician (EP) [1, 2].Focused ultrasonography (f-us) is a noninvasive bedside tool, generally free of pain and ionizing radiation, fairly easy to learn and associated with a reduction in the use of more cumbersome imaging [3,4,5]. Studies have shown that f-us in selected patients can increase the diagnostic accuracy by increasing the sensitivity to up to 97% when adding f-us alongside standard clinical examination compared to a sensitivity as low as 50% by standard clinical examination alone indicating that f-us holds the potential to reduce the time to correct diagnosis and correct initial treatment [10]. Alongside these studies, evidence-based guidelines that describe indications, technical performance and interpretation of f-us as well as recommendations and guidelines of the implementation of f-us in ED or intensive care units have been published [11,12,13]. We aim to describe the feasibility, validity and diagnostic yield of a routine whole-body-focused ultrasonography (wbf-us) in an unselected group of high-acuity ED patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
