title: Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea.
abstract: OBJECTIVE
  The etiologic diagnosis of acute dyspnea in the emergency department (ED) remains difficult, especially for elderly patients or those with previous cardiorespiratory medical history. This may lead to inappropriate treatment and potentially a higher mortality rate. Our objective was to evaluate the performance of cardiopulmonary ultrasound compared with usual care for the etiologic diagnosis of acute dyspnea in the ED.
  
  
  METHODS
  Patients admitted to the ED for acute dyspnea underwent upon arrival a cardiopulmonary ultrasound performed by an emergency physician, in addition to standard care. The performances of the clinical examination, chest x-ray, N-terminal brain natriuretic peptide (NT-proBNP), and cardiopulmonary ultrasound were compared with the final diagnosis made by 2 independent physicians.
  
  
  RESULTS
  One hundred thirty patients were analyzed. For the diagnosis of acute left-sided heart failure, cardiopulmonary ultrasound had an accuracy of 90% (95% confidence interval [CI], 84-95) vs 67% (95% CI, 57-75), P = .0001 for clinical examination, and 81% (95% CI, 72-88), P = .04 for the combination "clinical examination-NT-proBNP-x-ray". Cardiopulmonary ultrasound led to the diagnosis of pneumonia or pleural effusion with an accuracy of 86% (95% CI, 80-92) and decompensated chronic obstructive pulmonary disease or asthma with an accuracy of 95% (95% CI, 92-99). Cardiopulmonary ultrasound lasted an average of 12 ± 3 minutes.
  
  
  CONCLUSIONS
  Cardiopulmonary ultrasounds performed in the ED setting allow one to rapidly establish the etiology of acute dyspnea with an accuracy of 90%.
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France. Electronic address: emeric.gallard@laposte.net.
authors.forename: Emeric
authors.initials: E
authors.lastname: Gallard
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Redonnet
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
authors.forename: Jean-Eudes
authors.initials: JE
authors.lastname: Bourcier
authors.affiliation: Unité de Soutien Méthodologique à la Recherche, Laboratoire d'Épidémiologie, Centre Hospitalier Universitaire de Toulouse, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Deshaies
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Largeteau
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Amalric
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Chedaddi
authors.affiliation: Centre Francophone de Formation en Echographie, Centre Médical Delta, Nîmes, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Bourgeois
authors.affiliation: Emergency, Anesthesiology, and Critical Care Department, Lourdes Hospital, Lourdes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Garnier
authors.affiliation: Anesthesiology and Critical Care Department, Toulouse University Hospital, University Toulouse 3 Paul Sabatier, Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology*; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010808:Physical Examination; D010996:Pleural Effusion / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain