title: Lung ultrasound in heart failure: Lessons from re-analysis of Lung Ultrasound 2011 database.
abstract: Introduction: In the setting of patients presenting with shortness of breath to an Emergency Department a simple lung ultrasound protocol aimed at detecting pulmonary oedema has been shown to have diagnostic accuracy of 85%. This article reviews data from the original study, in an attempt to determine whether adjusting the protocol and/or interpretive criteria would improve results.Method: A large lung ultrasound project provided the dataset. Inter-rater and intertest discrepancies were reviewed. Then original stored images and comments were retrospectively analysed using alternate interpretive criteria. Specific variations included changing the number of B-lines required to define 'wet lung' and assessing other pleural line abnormalities. Where they had been acquired cardiac loops were reviewed in addition to the lung images.Results: The 204 original studies available were reviewed. Some disagreement could be attributed to inexperience and unclear definitions. Adjusting the number of B-lines did not improve diagnostic accuracy. All positive scans, with numerous B-lines were reviewed using more advanced diagnostic criteria (pleural line abnormalities) and the number of false positives was decreased. In cases where cardiac views were available, their inclusion was beneficial.Conclusion: A simple lung ultrasound protocol to assess for 'wet lung' in patients presenting to Emergency Departments provides diagnostic accuracy of around 85% in the hands of relative novices. More advanced interpretation of the same_ultrasound images, and the addition of cardiac views, is likely to further improve diagnostic accuracy.
authors.affiliation: Ipswich General HospitalEmergency DepartmentIpswichQueenslandAustralia; University of QueenslandIpswichQueenslandAustralia.
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 QueenslandIpswichQueenslandAustralia; Cardiac Imaging FellowRadiology, 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 Queensland Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Stieler
authors.affiliation: Sir Charles Gairdner Hospital Nedlands Western Australia Australia.
authors.forename: James
authors.initials: J
authors.lastname: Rippey
keywords: heart failure; lung ultrasound protocol; pulmonary oedema