Tiziano Perrone1, Alessia Maggi2, Carmelo Sgarlata2, Ilaria Palumbo2, Elisa Mossolani2, Sara Ferrari2, Ariel Melloul2, Roberta Mussinelli2, Michele Boldrini2, Ambra Raimondi2, Aderville Cabassi3, Francesco Salinaro4, Stefano Perlini5. 1. Clinica Medica I, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy. 2. Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy. 3. Cardiorenal Research Unit, Department of Clinical and Experimental Medicine, University of Parma, Italy. 4. Emergency Department, Fondazione Policlinico IRCCS San Matteo, University of Pavia, Italy; Experimental Medicine PhD Program, University of Pavia, Pavia, Italy. 5. Clinica Medica II, Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy. Electronic address: stefano.perlini@unipv.it.
Abstract
BACKGROUND: Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. STUDY DESIGN AND METHODS: The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81±9years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as "cardiac" (n=80), "respiratory" (n=36) or "mixed" (n=14), according to the discharge diagnosis (congestive heart failure either alone [n=80] or associated with pneumonia [n=14], pneumonia [n=24], and obstructive disventilatory syndrome [n=12]). An 8-window LUS protocol was applied to evaluate B-line distribution, "interstitial syndrome" pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. RESULTS: The presence of a generalized "interstitial syndrome" at the initial LUS evaluation allowed to discriminate "cardiac" from "pulmonary" Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%-97.94%) and specificity (86.11%; 70.50%-95.33%). Positive and negative predictive values were 93.76% (86.03%-97.94%) and 86.09% (70.47%-95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. CONCLUSIONS: Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.
BACKGROUND:Dyspnea is one of the most frequent causes of admission in Internal Medicine wards, leading to a sizeable utilization of medical resources. STUDY DESIGN AND METHODS: The role of bedside lung ultrasound (LUS) was evaluated in 130 consecutive patients (age: 81±9years), in whom blindly collected LUS results were compared with data obtained by clinical examination, medical history, blood analysis, and chest X-ray. Dyspnea etiology was classified as "cardiac" (n=80), "respiratory" (n=36) or "mixed" (n=14), according to the discharge diagnosis (congestive heart failure either alone [n=80] or associated with pneumonia [n=14], pneumonia [n=24], and obstructive disventilatory syndrome [n=12]). An 8-window LUS protocol was applied to evaluate B-line distribution, "interstitial syndrome" pattern, pleural effusion and images of static or dynamic air bronchogram/focal parenchymal consolidation. RESULTS: The presence of a generalized "interstitial syndrome" at the initial LUS evaluation allowed to discriminate "cardiac" from "pulmonary" Dyspnea with high sensitivity (93.75%; confidence intervals: 86.01%-97.94%) and specificity (86.11%; 70.50%-95.33%). Positive and negative predictive values were 93.76% (86.03%-97.94%) and 86.09% (70.47%-95.32%), respectively. Moreover, LUS diagnostic accuracy for the diagnosis of pneumonia was not inferior to that of chest X-ray. CONCLUSIONS: Bedside LUS evaluation contributes with high sensitivity and specificity to the differential diagnosis of Dyspnea. This holds true not only in the emergency setting, but also in the sub-acute Internal Medicine arena. A wider use of this portable technique in our wards is warranted.
Authors: Kathryn Watson; Ada Lam; Shane Arishenkoff; Samantha Halman; Neil E Gibson; Jeffrey Yu; Kathryn Myers; Marcy Mintz; Irene W Y Ma Journal: BMC Med Educ Date: 2018-09-20 Impact factor: 2.463
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