title: Accuracy of Nurse-Performed Lung Ultrasound in Patients With Acute Dyspnea: A Prospective Observational Study.
abstract: In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea in our Medicine Department between April and July 2014. At admission, serum brain natriuretic peptide (BNP) levels and LUS was performed by trained nurses blinded to clinical and laboratory data. The accuracy of nurse-performed LUS alone and combined with BNP for the diagnosis of acute cardiogenic dyspnea was calculated. Two hundred twenty-six patients (41.6% men, mean age 78.7 ± 12.7 years) were included in the study. Nurse-performed LUS alone had a sensitivity of 95.3% (95% CI: 92.6-98.1%), a specificity of 88.2% (95% CI: 84.0-92.4%), a positive predictive value of 87.9% (95% CI: 83.7-92.2%) and a negative predictive value of 95.5% (95% CI: 92.7-98.2%). The combination of nurse-performed LUS with BNP level (cut-off 400 pg/mL) resulted in a higher sensitivity (98.9%, 95% CI: 97.4-100%), negative predictive value (98.8%, 95% CI: 97.2-100%), and corresponding negative likelihood ratio (0.01, 95% CI: 0.0, 0.07). Nurse-performed LUS had a good accuracy in the diagnosis of acute cardiogenic dyspnea. Use of this technique in combination with BNP seems to be useful in ruling out cardiogenic dyspnea. Other studies are warranted to confirm our preliminary findings and to establish the role of this tool in other settings.
authors.affiliation: From the Department of Internal Medicine, Ospedale Civile di Livorno, Livorno (NM, AC, MC, VB, BB, ER, LG, LM, MC), Department of Internal Medicine, Ospedale di Circolo, Varese (JV, FD), and Emergency Department, Ospedale della Val d'Arda, Piacenza (MGP), Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mumoli
authors.forename: Josè
authors.initials: J
authors.lastname: Vitale
authors.forename: Matteo
authors.initials: M
authors.lastname: Giorgi-Pierfranceschi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cresci
authors.forename: Marco
authors.initials: M
authors.lastname: Cei
authors.forename: Valentina
authors.initials: V
authors.lastname: Basile
authors.forename: Barbara
authors.initials: B
authors.lastname: Brondi
authors.forename: Elisa
authors.initials: E
authors.lastname: Russo
authors.forename: Lucia
authors.initials: L
authors.lastname: Giuntini
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Masi
authors.forename: Massimo
authors.initials: M
authors.lastname: Cocciolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
mesh_terms: D000208:Acute Disease; D000368:Aged; D004417:Dyspnea / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009733:Nursing Diagnosis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods / Q000592:standards
chemical_list: D020097:Natriuretic Peptide, Brain