title: Diagnostic accuracy of basic lung ultrasound in breathless patients over 60 years of age; stressing the protocol.
abstract: Introduction: Emergency department differentiation of pulmonary oedema from chronic obstructive airways disease causing acute breathlessness is inaccurate 25% of the time despite clinical acumen, clinician-reported chest x-ray and ECG. This research investigates whether a basic lung ultrasound protocol (LUS) could improve identification of pulmonary oedema in breathless elderly patients.Method: Researchers prospectively sampled patients over 60 years, describing any breathlessness on presentation to a suburban emergency department. LUS studies were acquired by experienced or novice sonologists, interpreted by a blinded reviewer and compared with cardiologist chart audit for diagnosis at admission (gold standard). The admitting doctor's diagnosis, blinded to LUS, was compared with the chart audit result.Results: 204 LUS were collected, 145 by experienced sonologist and 59 by inexperienced. Diagnostic accuracy compared to cardiologist audit was 86.2% (95% CI 80.9 to 90.3), significantly higher than 70.2%, diagnostic accuracy for admission diagnosis, difference in proportion of 16% (95%CI 7.7 to 24.4%).Conclusion: A simple lung scanning protocol can help exclude pulmonary oedema in any breathless elderly patient.
authors.affiliation: Ipswich General HospitalEmergency Department IpswichQueenslandAustralia; University of Queensland IpswichQueenslandAustralia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Baker
authors.affiliation: University of Queensland Ipswich Queensland Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mitchell
authors.affiliation: University of Queensland IpswichQueenslandAustralia; St Paul's HospitalRadiology DepartmentVancouverBCCanada.
authors.forename: Angus G
authors.initials: AG
authors.lastname: Thompson
authors.affiliation: Department of Medical Imaging Royal Brisbane and Women's Hospital Herston Brisbane Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Stieler
keywords: accuracy; breathlessness; emergency; lung ultrasound; pulmonary oedema