Abstract
BackgroundAn improved prehospital diagnostic accuracy of cardiogenic pulmonary oedema could potentially improve initial treatment, triage, and outcome. A pilot study was conducted to assess the feasibility, time-use, and diagnostic accuracy of prehospital lung ultrasound (PLUS) for the diagnosis of cardiogenic pulmonary oedema.MethodsA prospective observational study was conducted in a prehospital setting. Patients were included if the physician based prehospital mobile emergency care unit was activated and one or more of the following two were present: respiratory rate >30/min., oxygen saturation <90 %. Exclusion criteria were: age <18 years, permanent mental disability or PLUS causing a delay in life-saving treatment or transportation. Following clinical assessment PLUS was performed and presence or absence of interstitial syndrome was registered. Audit by three physicians using predefined diagnostic criteria for cardiogenic pulmonary oedema was used as gold standard.ResultsA total of 40 patients were included in the study. Feasibility of PLUS was 100 % and median time used was 3 min. The gold standard diagnosed 18 (45.0 %) patients with cardiogenic pulmonary oedema. The diagnostic accuracy of PLUS for the diagnosis of cardiogenic pulmonary oedema was: sensitivity 94.4 % (95 % confidence interval (CI) 72.7–99.9 %), specificity 77.3 % (95 % CI 54.6–92.2 %), positive predictive value 77.3 % (95 % CI 54.6–92.2 %), negative predictive value 94.4 % (95 % CI 72.7–99.9 %).DiscussionThe sensitivity of PLUS is high, making it a potential tool for ruling-out cardiogenic pulmonary. The observed specificity was lower than what has been described in previous studies.ConclusionsPerformed, as part of a physician based prehospital emergency service, PLUS seems fast and highly feasible in patients with respiratory failure. Due to its diagnostic accuracy, PLUS may have potential as a prehospital tool, especially to rule out cardiogenic pulmonary oedema.
Highlights
State the research questions or study aims, such as estimating diagnostic accuracy or p. 6 comparing accuracy between tests or across participant groups
From the viewpoint that the lung was an organ that ultrasound could not be used to investigate, several studies have shown that Lung ultrasound (LUS) can be used for a variety of the most common diagnosis seen in emergency medicine and traumatology [1, 2]
The results suggest that prehospital lung ultrasound (PLUS) have a high diagnostic accuracy for the diagnosis of cardiac pulmonary oedema
Summary
State the research questions or study aims, such as estimating diagnostic accuracy or p. 6 comparing accuracy between tests or across participant groups. A pilot study was conducted to assess the feasibility, time-use, and diagnostic accuracy of prehospital lung ultrasound (PLUS) for the diagnosis of cardiogenic pulmonary oedema. Laursen et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2016) 24:96 pulmonary oedema [4, 6] This pragmatic assumption has been validated in an emergency department setting [5, 7]. Using this assumption LUS has been shown to have a high diagnostic accuracy for the diagnosis of cardiogenic pulmonary oedema which surpasses history taking, clinical examination, blood samples and chest xray [5]. Secondary aims were to assess time-use, and diagnostic accuracy for cardiogenic pulmonary oedema
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