title: Prehospital chest emergency sonography trial in Germany:  a prospective study.
abstract: OBJECTIVE
  To examine the feasibility and diagnostic value of a novel prehospital chest ultrasound algorithm in patients with dyspnea.
  
  
  METHODS
  Sixty-two patients (32 men, 30 women, mean 67.1 years, range 20-90 years) with acute dyspnea prospectively underwent chest sonography with a portable ultrasound device. The algorithm included five sectional views (four-chamber subxyphoidal view, left and right laterodorsal view, left and right anterior intercostal space two to four view) screening for pleural and pericardial effusion, right heart distension, and pneumothorax. The prehospital sonographic findings were confirmed by chest radiograph, ultrasonography, and clinical follow-up in the emergency department.
  
  
  RESULTS
  Prehospital chest emergency sonography trial was completed in 56 patients. Mean examination time was 2 min, and no scan took longer than 5 min. Sonography was easily integrated in the prehospital workflow alongside paramedic treatment without delay of treatment or transport. The most common diagnoses associated with acute dyspnea were (a) acute coronary syndrome (n=12, 21%), (b) decompensated congestive heart failure (CHF) (n=11, 20%), and (c) chronic obstructive pulmonary disease (COPD) (n=10, 18%). Pleural effusion was detected in 100% of CHF, 17% of acute coronary syndrome, and 20% of COPD patients, constituting a highly significant parameter in the differential diagnosis (P<0.01). Ultrasonography provided a helpful tool in n=38 (68%), and additional therapeutic consequences were drawn in n=14 (25%).
  
  
  CONCLUSIONS
  Prehospital chest emergency sonography trial is a novel prehospital ultrasound algorithm for patients with dyspnea. Pleural effusion may serve as a novel prehospital marker for patients with decompensated CHF, thus facilitating the often difficult differential diagnosis between CHF and COPD.
authors.affiliation: Division of Interdisciplinary Prehospital Emergency Medicine, University Giessen and Marburg, Marburg, Germany. neesse@med.uni-marburg.de
authors.forename: Albrecht
authors.initials: A
authors.lastname: Neesse
authors.forename: Andreas
authors.initials: A
authors.lastname: Jerrentrup
authors.forename: Saskia
authors.initials: S
authors.lastname: Hoffmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Sattler
authors.forename: Christian
authors.initials: C
authors.lastname: Görg
authors.forename: Clemens
authors.initials: C
authors.lastname: Kill
authors.forename: Thomas Mathias
authors.initials: TM
authors.lastname: Gress
authors.forename: Steffen
authors.initials: S
authors.lastname: Kunsch
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging; D013223:Statistics as Topic; D013909:Thorax / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000295:instrumentation* / Q000379:methods; D055815:Young Adult