Dyspnea In Emergency Department Research Articles

Diagnostic Utility of NT-Pro BNP in Elderly Patients Presenting With Acute Dyspnea in Emergency Department

ABSTRACT
 BACKGROUND: Acute dyspnea may be related to lungs pathology or cardiac pathology or due to involvement of both. Rapid diagnosis of the cause of dyspnea in emergency can help in early start of treatment preventing further progress of the symptoms, prolong hospital stay, need of more invasive medical procedures like intubation and ventilation thereby decrease the morbidity and mortality of the patients.
 METHODOLOGY: The study was conducted for three months i.e, from 16th May 2023 till 17th August 2023. 150 patients fulfilling inclusion criteria were taken. Clinical diagnosis in these patients was established based on medical history as well as echo and chest X-ray. Based on their clinical diagnosis, the patients were divided into three groups: group A diagnosed with pulmonary dyspnea (PD), group B diagnosed with congestive heart failure (CHF), and group C diagnosed with combined dyspnea (CHF+PD). NT-proBNP level in these patients was measured and compared.
 RESULTS: The study population constituted 60% males and 40% female with mean age of 68.9±10.99. Out of 150 patients presenting with acute dyspnea in emergency department, 65 patients were diagnosed with congestive heart failure, 55 patients were diagnosed with pulmonary dyspnea and 30 patients diagnosed with combined dyspnea. Average NT-proBNP among group A patients was (1300±175) ng/l, among group B patients was (275±70) ng/l and among group C patients was (1276±165) ng/l.
 CONCLUSION: NT-proBNP is the reliable marker to differentiate the cardiac and pulmonary causes of acute dyspnea among elderly patients presenting to emergency.
 
 KEY WORDS: N-terminal pro-B-type natriuretic peptide (NT-proBNP), emergency, elderly patients, dyspnea, biomarker

Role of Transthoracic Ultrasound in Patient with Acute Dyspnea in Emergency Department

Role of Transthoracic Ultrasound in Patient with Acute Dyspnea in Emergency Department

Approach to undifferentiated dyspnea in emergency department

Studied cases with acute dyspnea may benefit from quick diagnosis & effective treatment that can save their lives. Emergency patient's history, physical examination, chest radiography, 12-lead electrocardiography, & measurement of brain natriuretic peptide or N-terminal pro-BNP are all techniques for evaluating studied cases who may have acute decompensated heart failure. Chest USG has attracted interest recently since it can be used to diagnose acute respiratory failure in intensive care units. Both cardiac & non-cardiac causes were present in sizable portion of studied cases (twenty eight percent) who presented with dyspnea. Therefore, it is crucial to conduct thorough investigations for all principal reasons for dyspnea in every studied case because a large proportion of patients may have various diseases processes that are accountable for their symptoms.

Myocardial injury defined as elevated high-sensitivity cardiac troponin T is associated with higher mortality in patients seeking care at emergency departments with acute dyspnea

BackgroundElevated levels of cardiac troponin T has been observed in patients seeking care at the emergency department (ED) presenting with chest pain but without myocardial infarction (MI). The clinical importance of this observation remains, however, still unclear. Our main aim was to study the role of cardiac troponin T in patients admitted to the emergency department with acute dyspnea, a group of patients with a high cardiovascular comorbidity, but no primary acute MI.Population and methodsPatients from the age of 18 seeking care at the ED for dyspnea, without an acute cardiac syndrome, and with a recorded assessment of high-sensitivity cardiac troponin T (hs-cTnT), were included (n = 1001). Patients were categorized into 3 groups by hs-cTnT level, i.e. <15, 15–100 and > 100 µg/l. Cox regression with Hazard Ratios (HRs) and 95% Confidence Intervals (CI) for 3-months mortality was performed, with adjustment for sex, age, respiratory frequency, saturation, CHF, renal disease, and BMI.ResultsFully adjusted HRs (95% CI) for 3-month mortality, with hs-cTnT < 15 µg/l as reference level, showed for hs-cTnT 15–100 a HR of 3.682 (1.729–7.844), and for hs-cTnT > 100 a HR of 10.523 (4.465–24.803).ConclusionElevated hs-cTnT seems to be a relevant marker of poor prognosis in patients with acute dyspnea without MI and warrants further validation and clinical testing.

POCUSTO DIFFERENTIATE DYSPNEAPRESENTING TO EMERGENCY DEPARTMENT

Background: Emergency department(ED) faces challenges in diagnosis and management of patients presenting with acute dyspnea due to resource limited settings. Hence the present study was conducted with the main aim of evaluating a diagnostic strategy using point of care ultrasonography (POCUS) to distinguish patients presenting with acute dyspnea to ED into different diagnostic categories for timely management. Methods: This is a prospective cohort study conducted with total of 50 patients. To assess the diagnostic accuracy of using POCUS in evaluating patients presenting with dyspnea as a predominant complaint to ED. POCUS includes lung-cardiac-IVC, lung usg to identify( diffuse B lines, lung sliding sign, consolidation, pleural effusion etc.,), cardiac usg for left ventricular function, right atrial and right ventricular enlargement, pericardial effusion, cardiac tamponade, inferior vena cava(IVC) diameter and collapsibility. Later, out of nine POCUS diagnosis defined in the study algorithm patients were treated and compared with final hospital diagnosis to estimate the accuracy of this strategy. Results: ED diagnosis of dyspnea using the diagnostic strategy proposed in the study was in compliance with final hospital diagnosis with high agreement in 86% of patients with Kappa statistic = 0.798 (p&lt;0.001) which is statisticaly significant.Acute decompensated heart failure (ADHF) was the most common diagnosis. 98.69% and 96.23% was the sensitivity and specificity of the diagnostic strategy used in this study to identify ADHF. A significant (p&lt;0.01) proportion of patients presenting with dyspnea had Presence of ARDS with ADHF. Conclusion:Incorporating POCUS by lung-cardiac-IVC into routine clinical evaluation yielded a higher accuracy in differentiating causes of dyspnea in ED, and hence this diagnostic strategy could be recommended even in resource-limited setting.

Use of POCUS in Chest Pain and Dyspnea in Emergency Department: What Role Could It Have?

Chest pain and dyspnea are common symptoms in patients presenting to the emergency room (ER); oftentimes it is not possible to clearly identify the underlying cause, which may cause the patient to have to return to the ER. In other cases, while it is possible to identify the underlying cause, it is necessary to perform a large number of tests before being able to make a diagnosis. Over the last twenty years, emergency medicine physicians have had the possibility of using ultrasound to help them make and rule out diagnoses. Specific ultrasound tests have been designed to evaluate patients presenting with specific symptoms to ensure a fast, yet complete, evaluation. In this paper, we examine the role of ultrasound in helping physicians understand the etiology behind chest pain and dyspnea. We analyze the different diseases and disorders which may cause chest pain and dyspnea as symptoms and discuss the corresponding ultrasound findings.

Persistent hyperlactatemia in decompensated type I diabetes with hepatic glycogenosis and hepatomegaly: Mauriac syndrome: a case report

BackgroundWe describe a case of Mauriac syndrome, which is a rare complication of poorly controlled type I diabetes that combines glycogenosis, hepatomegaly, growth retardation with a Cushingoid appearance that is most often present in children but also in young adults. Here we also describe another finding with this syndrome, which is hyperlactatemia.Case presentationThe case is of a 16-year-old female of North African ethnicity with history of poorly controlled type I diabetes who was brought to the emergency department for dyspnea and tachycardia, treated initially for diabetic ketoacidosis. Her persistent hyperlactatemia helped to reveal a more subtle condition known as Mauriac syndrome after multiple examinations and follow-up.ConclusionsThis case reports shows that Mauriac syndrome is a rare condition that should be considered in a setting of poorly controlled type I diabetes, hepatomegaly, Cushingoid appearance, and hyperlactatemia. The current treatment of this condition is a strict control of blood glucose levels with an attempt to achieve an acceptable glycated hemoglobin value.

Nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS

BackgroundSystemic histoplasmosis is a disease of high morbidity and mortality in immunocompromised patients. Patients with AIDS get the infection through inhalation of spores, triggering a primary lung infection with a subsequent hematogenous spread to multiple organs, including the skin. Tissue necrosis have been documented in cutaneous histoplasmosis with multiple clinical manifestations that mimic other diseases.Case presentationWe report the case of nasal cartilage destruction associated to cutaneous histoplasmosis in AIDS. A 24-year-old man, resident in Ecuadorian coast, with a history of HIV for 7 years without any treatment. In the last 3 months, he has been presenting a molluscum-like lesions on his nasal bridge with subsequent dissemination to the trunk and extremities. He was admitted to the emergency department for dyspnoea, cough, and malaise. Due to his respiratory failure, he was admitted to the intensive care unit (ICU) with mechanical ventilation. Physical examination reveals a crusted surface ulcer that involves the nose and cheeks, associated with erythematous papules, some with a crusted surface which are spread to the face, trunk, and upper limbs. The patient has a specific skin involvement with a butterfly-like ulcer appearance and destruction of the upper and lower lateral cartilage of the nose. At admission CD4 cell count was 11/mm3 with a HIV viral load of 322,908 copies. Mycological cultures identified Histoplasma capsulatum. A treatment with highly active antiretroviral therapy (HAART) was stablished, associated with liposomal amphotericin B at a dose of 3 mg/kg/day and itraconazole 200 mg twice a day for 12 months.ConclusionsCutaneous histoplasmosis is a rare manifestation of pulmonary histoplasmosis in patients with AIDS. The cutaneous manifestations included papules, nodules, plaques, and ulcers. A histology examination is required to rule out other fungal or parasitic infections. Treatment includes highly active antiretroviral therapy (HAART), amphotericin B liposomal and itraconazole, the latest for at least 12 months.

In acute dyspnea with diagnostic uncertainty, ACP suggests POCUS may be added to the standard diagnostic pathway.

Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al. Appropriate use of point-of-care ultrasonography in patients with acute dyspnea in emergency department or inpatient settings: a clinical guideline from the American College of Physicians. Ann Intern Med. 2021;174:985-93. 33900792.

Accuracy of lung ultrasound and chest X-rays in diagnosing acute pulmonary oedema in patients presenting with acute dyspnoea in emergency department.

To determine the diagnostic accuracy of lung ultrasound and chest X-ray in diagnosing Acute Pulmonary Oedema in patients presenting with acute dyspnoea in emergency department, a study was conducted at the emergency department of Shifa International Hospital, Islamabad, from July 31, 2018 to January 31, 2019. A total of 225 patients presenting with dyspnoea and satisfying the inclusion criteria were assessed through clinical examination, lung ultrasound (LUS) and chest X-ray. The results of chest X-ray and lung ultrasound were compared with clinical diagnosis. The study revealed sensitivity of chest X-ray and LUS (60.16% versus 91.05%), specificity (66.67% versus 91.18%), positive predictive value (68.52% versus 92.56%) and the negative predictive values (58.12% versus 89.42%) respectively. The present study revealed that the LUS has better accuracy than chest X-ray for diagnosis of acute pulmonary oedema.

To Access The Potential of Point of Care Ultrasound to Differentiate Various Causes of Dyspnea In Emergency Department

Management of the patients presented with dyspnea can be challenging in emergency department(ED), because differentiating underlying cause can be difficult and time consuming. Point of care ultrasound(POCUS) examination in early evaluation of critical patients have been reported to be helpful in rapid diagnosis of causes of dyspnea which in turn helps in early Resuscitation. Aim: We performed this study to assess utility of POCUS in differentiating causes of dyspnea &amp; compared with final diagnosis at the time of discharge/death. Settings and design: This was a single centre prospective diagnostic study to assess utility of POCUS in dyspnea. It was approved by ethical committee. Materials and methods: The study was conducted at ED of tertiary care government hospital in Central Gujarat from December 2018 to November 2019. All patients presenting with dyspnea to ED were included after written informed consent. Patients’ age &lt; 12 years, Patients not willing for admission, and Patient who took discharge against medical advice /absconded/died before establishing final diagnosis were excluded. Provisional diagnosis made through POCUS was compared with the final diagnosis made by the consultants of respective clinical departments during course of their hospitalization. Statistical analysis and results: 146 patients with dyspnea presenting to ED were included in prospective observational study. True and False positives, sensitivity and specificity were calculated from the analysis of data. Reliability index was calculated on the basis of above data. *Conclusion: This study showed good efficacy of POCUS in differentiating causes of dyspnea when compared with final medical diagnosis. Thus POCUS helps in early resuscitation and management.

Role of point-of-care ultrasound study in early disposition of patients with undifferentiated acute dyspnea in emergency department: a multi-center prospective study.

Sonography is a safe and simple diagnostic modality which can help emergency physicians in their clinical decision makings and improve the patient disposition process in emergency departments. This prospective multi-center study evaluates the role of bedside ultrasound performed by emergency physicians in accelerating the patient disposition process in cases with acute undifferentiated dyspnea. 103 patients were randomized to "early ultrasound" and "routine assessment" groups. In early ultrasound group, emergency physicians performed bedside ultrasound scans on heart and lungs as soon as possible after triage and randomization. In routine assessment group, ultrasound was used whenever the emergency physician or other consultant services ordered or performed it. Mean randomization-to-diagnosis time was compared in two studied groups. Mean randomization-to-diagnosis time was 79.33 (± 38.90) min in routine assessment and 42.61 (± 19.20) min in early ultrasound groups, showing a statistically significant difference (p value < 0.01). Using early sonography in assessing the patients with undifferentiated acute dyspnea in emergency department decreases the patient turnover time while increasing the diagnostic accuracy.

Appropriate Use of Point-of-Care Ultrasonography in Patients With Acute Dyspnea in Emergency Department or Inpatient Settings: A Clinical Guideline From the American College of Physicians.

The American College of Physicians (ACP) developed this guideline to provide clinical recommendations on the appropriate use of point-of-care ultrasonography (POCUS) in patients with acute dyspnea in emergency department (ED) or inpatient settings to improve the diagnostic, treatment, and health outcomes of those with suspected congestive heart failure, pneumonia, pulmonary embolism, pleural effusion, or pneumothorax. The ACP Clinical Guidelines Committee based this guideline on a systematic review on the benefits, harms, and diagnostic test accuracy of POCUS; patient values and preferences; and costs of POCUS. The systematic review evaluated health outcomes, diagnostic timeliness, treatment decisions, and test accuracy. The critical health, diagnostic, and treatment outcomes evaluated were in-hospital mortality, time to diagnosis, and time to treatment. The important outcomes evaluated were intensive care unit admissions, correctness of diagnosis, disease-specific outcomes, hospital readmissions, length of hospital stay, and quality of life. The critical test accuracy outcomes included false-positive results for suspected pneumonia, pneumothorax, and pulmonary embolism and false-negative results for suspected congestive heart failure, pneumonia, pneumothorax, and pulmonary embolism. Important test accuracy outcomes included false-positive results for suspected congestive heart failure and false-negative and false-positive results for suspected pleural effusion. This guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. The target audience is all clinicians, and the target patient population is adult patients with acute dyspnea in ED or inpatient settings. ACP suggests that clinicians may use point-of-care ultrasonography in addition to the standard diagnostic pathway when there is diagnostic uncertainty in patients with acute dyspnea in emergency department or inpatient settings (conditional recommendation; low-certainty evidence).

Energy Drinks Induced Atrial Fibrillation

Introduction: Atrial fibrillation (AF) is most common in adulthood supraventricular arrhythmia. Some of our ways of life the occurrence of this arrhythmia possible. Recently, it is common to consume energy drinks (ED), especially among young people. Caffeine is found in energy drinks. Their adverse effects, not yet completely known, are usually considered secondary to a high concentration of caffeine. Here we focus on a particular acute cardiac complication of EDs overconsumption: atrial fibrillation.&#x0D; &#x0D; Case report: A 23-year-old man, was referred to our emergency department for dyspnea, palpitations, and anxiety. The patient had a negative family, personal, and pharmacological history. About two hours before, he has consumed 750ml of ED. At admission, blood pressure was 104/62. An ECG revealed a high rate of atrial fibrillation at 162bpm. Laboratory investigation revealed that complete blood count and routine biochemical blood levels were within normal limits. Transthoracic echocardiogram excluded the presence of cardiac disease, the left atrium was slightly dilated, as expected. According to guidelines patient was treated with propafenone and recovered a normal sinus rhythm.&#x0D; &#x0D; Conclusion: As in our case, PAF can occur due to ED consumption, and awareness about this adverse effect of ED consumption is important.

Focused Cardiac Ultrasound in Dyspnea of Unclear Etiology in the Emergency Department: Utility of the FLUID Score.

We evaluated the utility of focused cardiac ultrasound to predict the length of stay in patients presenting to the emergency department with dyspnea of unclear etiology. Patients with focused cardiac ultrasound examinations performed in the emergency department for dyspnea over a 34-month period were retrospectively identified. Patients were excluded if they had a prior diagnosis of heart failure, dialysis requirement, or an etiology of dyspnea unrelated to the volume status. Left ventricular function was categorized as normal or reduced, and the inferior vena cava was categorized as normal or increased volume. A fast limited ultrasound to investigate dyspnea (FLUID) score was calculated by adding 1 point for reduced left ventricular function and 1 point for increased volume, producing a score of 0, 1, or 2. There were 123 patients included. There was a significant correlation between the FLUID score and length of stay, with longer stays for higher scores (FLUID score 0, 7.4 hours median; FLUID score 1, 2.34 days; FLUID score 2, 5.56 days; analysis of variance P < .001). Of the other variables collected, only age, hypertension, diabetes, heart rate, and brain natriuretic peptide were significantly correlated with the length of stay. A multivariate analysis including those variables and the FLUID score showed that the FLUID score was the strongest independent predictor of the length of stay. Focused cardiac ultrasound and calculation of a FLUID score for patients with undifferentiated dyspnea can be a powerful tool to predict the hospital length of stay.

Evaluation of a new respiratory monitoring tool “Early Warning ScoreO2” for patients admitted at the emergency department with dyspnea

BackgroundMany scores derived from Early Warning Scores have been developed to detect patients at risk of poor outcome. Few of these scores incorporate the oxygen flow rate while this is a major marker in patients with respiratory complaint. We developed and evaluated a new automatable monitoring tool (Early Warning Score O2: EWS.O2) that incorporates cardio-respiratory parameters (Respiratory rate, Heart rate, SpO2, and FiO2 derived from oxygen flow rate), aiming to achieve early detection of poor outcome among patients with dyspnea. MethodsAll patients presenting at an emergency department for dyspnea from June 2011 to June 2018 with available initial value (nurse triage) of respiratory parameters were included. Our primary endpoint was a composite criterion including the use of non-invasive ventilation, ICU admission and death. The Area under the Receiver Operating Characteristic curve (AUROC) of the SpO2/FiO2 index, NEWS, NEWS2, and the EWS.O2 were compared, including in subgroup analysis by final diagnosis or oxygen supplementation. ResultsAmong the 1729 patients retrieved, the composite outcome was observed in 288 (16.7%). The EWS.O2 displayed better or comparable predictive accuracy at triage (AUROC: 0.704, 95% CI 0.672–0.736) compared to NEWS (0.662, p < 0.01), NEWS2 (0.672, p = 0.02) and SpO2/FiO2 (0.695, p = 0.46). ConclusionsThis new ScoreO2 is equivalent or superior to common early warning scores and index to predict poor outcome at first medical contact. This score may be automatically and continuously recorded with new closed-loop devices to titrate oxygen flow. Further prospective studies will allow to verify its accuracy at multiple time points of the patient’s journey.

P646 Cardiac tamponade as initial manifestation of small cell lung carcinoma

Abstract We report the case of a 69 years old woman, ex-smoker, with a history of hypertension, dyslipidemia, diabetes and right leg partial amputation after childhood osteomyelitis, presented at the emergency department for dyspnoea, posterior thoracic pain and progressive distention of the abdomen. She was tachycardic, slightly hypoxemic but normotensive. Electrocardiography: sinus tachycardia, normal axis, diffuse microvoltage and electric alternans. Chest X-ray showed enlarged cardiac silouhette, bilateral pleural effusion and upper right pulmonary lobe consolidation. Transthoracic echocardiography revealed large pericardial effusion, swinging heart, right atrial and right ventricular colapse, significant respiratory variation of transmitral and transtricuspidian flow, dilated inferior vena cava without respiratory variation, all suggesting cardiac tamponade. Computed tomography showed a mediastinal and pulmonary mass in the upper right pulmonary lobe, invading the posterior right thoracic wall and multiple mediastinal voluminous lymphadenopaty and ascites. She became hypotensive and was transferred to a tertiary hospital for urgent drainage of pericardial effusion. Over 1200 mL of serohematic fluid was evacuated with the removal of the drainage catheter in the following 48 hours. A biopsy was performed through bronchoscopy and small cell carcinoma of the lung was diagnosed. Considering the advanced stage of the carcinoma the option of pallative treatment was pursued. Discussions Chronic accumulation of large amounts of pericardial fluid is well tolerated, especially in patients that have limited physical activity. Ecocardiography allows early detection of cardiac tamponade. Development of cardiac tamponade in the evolution of malignancy confers a poor prognosis. The particularity of the case Cardiac tamponade as initial manifestation of lung cancer is a very rare occurrence and only limited data exist in literature. Conclusion Simultaneous presence of ascites, pleural and pericardial effusion should rise the suspicion of malignancy. Abstract P646 Figure.

Acute dyspnea in Emergency Department: point of care ultrasound in the diagnosis of atrial sarcoma

We describe a rare case of a 65-year-old patient presented to Emergency Department for acute dyspnea. Traditional diagnostic work-up was done and the emergency physician promptly performed a bedside point-of-care ultrasound. A giant mass in the left atrium was detected with impairing of mitral valve function. The patient was then sent to cardiac surgery department with a final diagnosis of high-grade cardiac sarcoma.

Approach to undifferentiated dyspnea in emergency department: aids in rapid clinical decision-making

BackgroundDiagnosis and management of patients presenting with acute dyspnea is one of the major challenges for physicians in emergency department (ED). A correct diagnosis is frequently delayed and difficult to ascertain, and clinical uncertainty is common, explaining the need for rapid diagnosis and a management plan. The primary aim of our study is to assess a diagnostic strategy using multiorgan point of care ultrasonography (USG) to differentiate patients presenting with acute dyspnea to ED into different diagnostic categories for timely management in a resource-limited setting.MethodsThis is a prospective cohort study which assessed the diagnostic performance of a strategy in evaluating patients presenting with undifferentiated dyspnea as primary predominant complaint to ED. Focused multiorgan USG which includes cardiac USG for left ventricle systolic function, right ventricle enlargement, and pericardial effusion, inferior vena cava (IVC) diameter and collapsibility, lung USG to identify various patterns (acute interstitial syndrome, pneumothorax, pleural effusion, consolidation, etc.) and renal USG to assess kidney size and echotexture was performed. Later, patients were grouped into one of ten clinical syndromes defined in the study based on USG and clinical patterns. Emergency diagnosis was compared with final hospital diagnosis to assess the accuracy of this strategy.ResultsConcordance between ED diagnosis of dyspnea using the diagnostic strategy proposed in the study with final hospital diagnosis was high with agreement in 88% of patients (Kappa statistic = .805, p = .000) which is statistically significant. The most common diagnosis was acute decompensated heart failure (ADHF). Sensitivity and specificity of the diagnostic strategy used in this study to identify ADHF was 97.3 and 93.3%, respectively. On multivariate analysis, jugular venous distension, fever and cough, ejection fraction (by eyeball method), dilated IVC, absent to decreased lung sliding showed independent association in predicting cardiac and non-cardiac diagnosis.ConclusionsThe present study concludes that integrating focused multiorgan USG by lung-cardiac-IVC and renal ultrasound into routine clinical evaluation of patients with dyspnea has a higher accuracy for differentiating causes of dyspnea in emergency department. This strategy can be adopted even in resource limited setting.

Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: The Brest score

ObjectiveTo derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting. DesignDerivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort. Interventions and MeasuresDuring the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee. ResultsThe score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (−2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9). ConclusionThis score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergency patients may enable a more rapid and efficient diagnostic process.