title: Immediate versus delayed integrated point-of-care-ultrasonography to manage acute dyspnea in the emergency department.
abstract: BACKGROUND
  Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ultrasound should help to differentiate cardiogenic from non-cardiogenic causes of dyspnea. We evaluated whether the diagnostic accuracy can be improved by adding a point-of-care-ultrasonography (POC-US) to routine exams and if an early use of this technique produces any advantage.
  
  
  METHODS
  One hundred sixty-eight patients were enrolled and randomized in two groups: Group 1 received an immediate POC-US in addition to routine laboratory and instrumental tests; group 2 received an ultrasound scan within 1 h from the admission to the Emergency Department. The concordance between initial and final diagnosis and the percentage of wrong diagnosis in the two groups were evaluated. Mortality, days of hospitalization in Emergency Medicine department and transfers to other wards were compared. Sensitivity and specificity of the routine protocol and the one including ultrasonography for the diagnosis of the causes of dyspnea were also analyzed.
  
  
  RESULTS
  Eighty-eight patients were randomized in group 1 and 80 in group 2. The concordance rate between initial and final diagnoses was significantly different (0.94 in group 1 vs. 0.22 in group 2, p < 0.005). The percentage of wrong initial diagnosis was 5% in group 1 and 50% in group 2 (p < 0.0001).
  
  
  CONCLUSIONS
  Adding POC-US to routine exams improves the diagnostic accuracy of dyspnea and reduces errors in the Emergency Department.
authors.affiliation: Emergency Medicine Department, San Paolo Hospital, Via Terracina 219, Naples 80125, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Pirozzi
authors.affiliation: Emergency Medicine Department, San Paolo Hospital, Via Terracina 219, Naples 80125, Italy.
authors.forename: Fabio G
authors.initials: FG
authors.lastname: Numis
authors.affiliation: Emergency Medicine Department, San Paolo Hospital, Via Terracina 219, Naples 80125, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pagano
authors.affiliation: Multidisciplinary Department of Medical Science, Second University of Naples, Via S. Pansini 5, Naples 80131, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Melillo
authors.affiliation: Emergency Medicine Department, Latisana Hospital, Cassacco, Udine 33010, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Copetti
authors.affiliation: Emergency Medicine Department, San Paolo Hospital, Via Terracina 219, Naples 80125, Italy.
authors.forename: Fernando
authors.initials: F
authors.lastname: Schiraldi
keywords: Diagnostic accuracy; Dyspnea; Emergency Department; Point-of-care-ultrasonography