title: SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department.
abstract: OBJECTIVE
  This study was conducted to evaluate a problem-oriented focused torso bedside ultrasound protocol termed "Sonographic Evaluation of Aetiology for Respiratory difficulty, Chest pain, and/or Hypotension" (SEARCH 8Es) for its ability to narrow differential diagnoses and increase physicians' diagnostic confidence, and its diagnostic accuracy, for patients presenting with dyspnea, chest pain, or symptomatic hypotension.
  
  
  METHODS
  This single-center prospective observational study was conducted over 12 months in an emergency department and included 308 patients (184 men and 124 women; mean age, 67.7 ± 19.1 years) with emergent cardiopulmonary symptoms. The paired t-test was used to compare the number of differential diagnoses and physician's level of confidence before and after SEARCH 8Es. The overall accuracy of the SEARCH 8Es protocol in differentiating 13 diagnostic entities was evaluated based on concordance (kappa coefficient) with the diagnosis made by the inpatient specialists. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
  
  
  RESULTS
  SEARCH 8Es narrows the number of differential diagnoses (2.5 ± 1.5 vs. 1.4 ± 0.7; p < 0.001) and improves physicians' diagnostic confidence (2.8 ± 0.8 vs. 4.3 ± 0.9; p < 0.001) significantly. The overall kappa coefficient value was 0.870 (p < 0.001), with the overall sensitivity, specificity, positive predictive value, and negative predictive value at 90.9%, 99.0%, 89.7%, and 99.0%, respectively.
  
  
  CONCLUSIONS
  The SEARCH 8Es protocol helps emergency physicians to narrow the differential diagnoses, increase diagnostic confidence and provide accurate assessment of patients with dyspnea, chest pain, or symptomatic hypotension.
authors.affiliation: Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Jung Hwan
authors.initials: JH
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam, Republic of Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Jeon
authors.affiliation: Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Hong-Chuen
authors.initials: HC
authors.lastname: Toh
authors.affiliation: Department of Emergency Medicine, University Hospital-Cleveland Medical Center, Cleveland, Ohio, United States of America.
authors.forename: Vicki Elizabeth
authors.initials: VE
authors.lastname: Noble
authors.affiliation: Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam, Republic of Korea.
authors.forename: Jun Su
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam, Republic of Korea.
authors.forename: Young Sik
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Dongguk University Ilsan Hospital, Graduate School of Medicine, Dongguk University, Goyang, Republic of Korea.
authors.forename: Han Ho
authors.initials: HH
authors.lastname: Do
authors.affiliation: Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam, Republic of Korea.
authors.forename: Young Rock
authors.initials: YR
authors.lastname: Ha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*