title: Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED.
abstract: Acute dyspnea is a common symptom in the ED. The standard approach to dyspnea often relies on radiologic and laboratory results, causing excessive delay before adequate therapy is started. Use of an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis, while maintaining an acceptable safety profile.
  
  
  
  Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled. The gold standard was the final diagnosis assessed by two expert reviewers. Two physicians independently evaluated the patient; a sonographer performed an ultrasound evaluation of the lung, heart, and inferior vena cava, while the treating physician requested traditional tests as needed. Time needed to formulate the ultrasound and the ED diagnoses was recorded and compared. Accuracy and concordance of the ultrasound and the ED diagnoses were calculated.
  
  
  
  A total of 2,683 patients were enrolled. The average time needed to formulate the ultrasound diagnosis was significantly lower than that required for ED diagnosis (24 ± 10 min vs 186 ± 72 min; P = .025). The ultrasound and the ED diagnoses showed good overall concordance (κ = 0.71). There were no statistically significant differences in the accuracy of PoCUS and the standard ED evaluation for the diagnosis of acute coronary syndrome, pneumonia, pleural effusion, pericardial effusion, pneumothorax, and dyspnea from other causes. PoCUS was significantly more sensitive for the diagnosis of heart failure, whereas a standard ED evaluation performed better in the diagnosis of COPD/asthma and pulmonary embolism.
  
  
  
  PoCUS represents a feasible and reliable diagnostic approach to the patient with dyspnea, allowing a reduction in time to diagnosis. This protocol could help to stratify patients who should undergo a more detailed evaluation.
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy. Electronic address: zanomau@libero.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zanobetti
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Scorpiniti
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Gigli
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Innocenti
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Valerio T
authors.initials: VT
authors.lastname: Stefanone
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Savinelli
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Coppa
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Sofia
authors.initials: S
authors.lastname: Bigiarini
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Caldi
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Tassinari
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Conti
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: Emergency Department, Careggi University Hospital, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pini
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000150:complications / Q000000981:diagnostic imaging; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications / Q000000981:diagnostic imaging; D010996:Pleural Effusion / Q000150:complications / Q000000981:diagnostic imaging; D011014:Pneumonia / Q000150:complications / Q000000981:diagnostic imaging; D011030:Pneumothorax / Q000150:complications / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging; D013995:Time; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: dyspnea; emergency medicine; ultrasound