Immediate echocardiography in the management of acute respiratory exacerbations of cardiopulmonary disease. A prospective study.
This prospective study was done to determine whether immediate echocardiography, to implicate or exclude a cardiac basis for breathlessness, can improve the management of acute dyspnea. One hundred ninety-six consecutive patients admitted to the hospital with a chief complaint of dyspnea were randomized to receive or not receive an echocardiogram within 24 hours of admission. Most patients randomized to echo and control groups had cardiac or pulmonary disease and were comparable in their other clinical characteristics. Predefined study end points included the following: change in diagnosis or treatment; performance of additional diagnostic cardiopulmonary studies; and duration of hospitalization (the principal end point). Changes in diagnosis or treatment during hospitalization were as infrequent among patients randomized to echo as among control patients. Echocardiography independently confirmed the clinical diagnosis in 72 percent of echo-randomized patients. Even when echo findings conflicted with the clinical diagnosis, the diagnosis and management plan rarely changed. Additional cardiac or pulmonary studies were ordered as frequently among patients randomized to echocardiography as among those randomized to control. The mean duration of hospital stay also did not differ between the two groups, and no clinical parameter served to predict which subgroup of patients might benefit from echocardiography. Although echocardiography can be expeditiously obtained during respiratory exacerbations of cardiopulmonary disease, indiscriminate echo does not necessarily hasten or alter the treatment of such patients.
Kudenchuk
P J
PJ
Department of Medicine, Oregon Health Sciences University, Portland.
Hosenpud
J D
JD
McDonald
R W
RW
Solin
R C
RC
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D013997:Time Factors