title: Prehospital lung ultrasound for the diagnosis of cardiogenic pulmonary oedema: a pilot study.
abstract: BACKGROUND
  An improved prehospital diagnostic accuracy of cardiogenic pulmonary oedema could potentially improve initial treatment, triage, and outcome. A pilot study was conducted to assess the feasibility, time-use, and diagnostic accuracy of prehospital lung ultrasound (PLUS) for the diagnosis of cardiogenic pulmonary oedema.
  
  
  METHODS
  A prospective observational study was conducted in a prehospital setting. Patients were included if the physician based prehospital mobile emergency care unit was activated and one or more of the following two were present: respiratory rate >30/min., oxygen saturation <90 %. Exclusion criteria were: age <18 years, permanent mental disability or PLUS causing a delay in life-saving treatment or transportation. Following clinical assessment PLUS was performed and presence or absence of interstitial syndrome was registered. Audit by three physicians using predefined diagnostic criteria for cardiogenic pulmonary oedema was used as gold standard.
  
  
  RESULTS
  A total of 40 patients were included in the study. Feasibility of PLUS was 100 % and median time used was 3 min. The gold standard diagnosed 18 (45.0 %) patients with cardiogenic pulmonary oedema. The diagnostic accuracy of PLUS for the diagnosis of cardiogenic pulmonary oedema was: sensitivity 94.4 % (95 % confidence interval (CI) 72.7-99.9 %), specificity 77.3 % (95 % CI 54.6-92.2 %), positive predictive value 77.3 % (95 % CI 54.6-92.2 %), negative predictive value 94.4 % (95 % CI 72.7-99.9 %).
  
  
  CONCLUSIONS
  The sensitivity of PLUS is high, making it a potential tool for ruling-out cardiogenic pulmonary. The observed specificity was lower than what has been described in previous studies.
  
  
  CONCLUSIONS
  Performed, as part of a physician based prehospital emergency service, PLUS seems fast and highly feasible in patients with respiratory failure. Due to its diagnostic accuracy, PLUS may have potential as a prehospital tool, especially to rule out cardiogenic pulmonary oedema.
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark. christian.b.laursen@rsyd.dk.|Clinical Institute, University of Southern Denmark, Odense, Denmark. christian.b.laursen@rsyd.dk.
authors.forename: Christian B
authors.initials: CB
authors.lastname: Laursen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Hänselmann
authors.affiliation: Clinical Institute, University of Southern Denmark, Odense, Denmark.|Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Stefan
authors.initials: S
authors.lastname: Posth
authors.affiliation: Clinical Institute, University of Southern Denmark, Odense, Denmark.|Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Mikkelsen
authors.affiliation: Department of Cardiology, Odense University Hospital, Odense, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Videbæk
authors.affiliation: Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Berg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012770:Shock, Cardiogenic / Q000150:complications*; D015996:Survival Rate / Q000639:trends
keywords: Heart failure; Lung; Prehospital; Pulmonary oedema; Sensitivity and specificity; Ultrasound