title: Accuracy of early rapid ultrasound in shock (RUSH) examination performed by emergency physician for diagnosis of shock etiology in critically ill patients.
abstract: BACKGROUND
  Rapid Ultrasound in Shock (RUSH) is a recently reported emergency ultrasound protocol designed to help clinicians better recognize distinctive shock etiologies in a short time. We tried to evaluate the accuracy of early RUSH protocol performed by emergency physicians to predict the shock type in critically ill patients.
  
  
  METHODS
  Our prospective study was approved by the ethics committee of trauma research center, Baqiyatallah University of Medical Science, Iran. We enrolled 52 patients with shock state in the emergency department from April 2013 to October 2013. We performed early bed-side sonographic examination for participants based on RUSH protocol. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final diagnosis. Agreement (Kappa index) of initial impression provided by RUSH with final diagnosis, and also sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RUSH for diagnosis of each shock type were calculated.
  
  
  RESULTS
  Fifty-two patients were enrolled in our study. Kappa index was 0.7 (P value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic and obstructive shocks, the protocol had sensitivity of 100% but had lower PPV. For shocks with distributive or mixed etiology, RUSH showed PPV of 100% but had low sensitivity. For cardiogenic shocks, all reliability indices were above 90%.
  
  
  CONCLUSIONS
  We highlight the role of RUSH examination in the hands of an emergency physician in making a rapid diagnosis of shock etiology, especially in ruling out obstructive, cardiogenic, and hypovolemic types.
authors.affiliation: Department of Emergency Medicine, Baqiyatallah University of Medical Science, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Ghane
authors.affiliation: Department of Radiology, Iran University of Medical Science, Tehran, Iran.
authors.forename: Mohammadhadi
authors.initials: M
authors.lastname: Gharib
authors.affiliation: Department of Surgery, Baqiyatallah University of Medical Science, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ebrahimi
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Science, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Saeedi
authors.affiliation: Department of Ophthalmology, Tehran University of Medical Science, Tehran, Iran.
authors.forename: Marjan
authors.initials: M
authors.lastname: Akbari-Kamrani
authors.affiliation: Researcher, Trauma Research Center, Baqiyatallah University of Medical Science, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Rezaee
authors.affiliation: Researcher, Trauma Research Center, Baqiyatallah University of Medical Science, Tehran, Iran.
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Rasouli
keywords: Accuracy; predictive value; rapid ultrasound in shock; shock; ultrasound