title: Diagnosing acute heart failure in patients with undifferentiated dyspnea: a lung and cardiac ultrasound (LuCUS) protocol.
abstract: OBJECTIVE
  The primary goal of this study was to determine accuracy for diagnosing acutely decompensated heart failure (ADHF) in the undifferentiated dyspneic emergency department (ED) patient using a lung and cardiac ultrasound (LuCUS) protocol. Secondary objectives were to determine if US findings acutely change management and if findings are more accurate than clinical gestalt.
  
  
  METHODS
  This was a prospective, observational study of adult patients presenting to the ED with undifferentiated dyspnea. The intervention consisted of a 12-view LuCUS protocol performed by experienced emergency physician sonographers. The primary objective was measured by comparing US findings to the final diagnosis independently determined by two physicians blinded to the LuCUS result. Acute treatment changes based on US findings were tracked in real time through a standardized data collection form.
  
  
  RESULTS
  Data on 99 patients were analyzed; ADHF was the final diagnosis in 36%. The LuCUS protocol had sensitivity of 83% (95% confidence interval [CI] = 67% to 93%), specificity of 83% (95% CI = 70% to 91%), positive likelihood ratio of 4.8 (95% CI = 2.7 to 8.3), and negative likelihood ratio of 0.20 (95% CI = 0.09 to 0.42). Forty-seven percent of patients had changes in acute management, and 42% had changes in acute treatment. Observed agreement for the LuCUS protocol was 93% between coinvestigators. Overall, accuracy improved by 20% (83% vs. 63%, 95% CI = 8% to 31% for the difference) over clinical gestalt alone.
  
  
  CONCLUSIONS
  The LuCUS protocol may accurately identify ADHF and may improve acute clinical management in dyspneic ED patients. This protocol has improved diagnostic accuracy over clinical gestalt alone.
authors: The Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
authors: Frances M
authors: FM
authors: Russell
authors: Robert R
authors: RR
authors: Ehrman
authors: Karen
authors: K
authors: Cosby
authors: Asim
authors: A
authors: Ansari
authors: Stephanie
authors: S
authors: Tseeng
authors: Errick
authors: E
authors: Christain
authors: John
authors: J
authors: Bailitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D004452:Echocardiography / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006321:Heart; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity