POCUSTO DIFFERENTIATE DYSPNEAPRESENTING TO EMERGENCY DEPARTMENT

Background: Emergency department(ED) faces challenges in diagnosis and management of patients presenting with acute dyspnea due to resource limited settings. Hence the present study was conducted with the main aim of evaluating a diagnostic strategy using point of care ultrasonography (POCUS) to distinguish patients presenting with acute dyspnea to ED into different diagnostic categories for timely management.

Methods: This is a prospective cohort study conducted with total of 50 patients. To assess the diagnostic accuracy of using POCUS in evaluating patients presenting with dyspnea as a predominant complaint to ED. POCUS includes lung-cardiac-IVC, lung usg to identify( diffuse B lines, lung sliding sign, consolidation, pleural effusion etc.,), cardiac usg for left ventricular function, right atrial and right ventricular enlargement, pericardial effusion, cardiac tamponade, inferior vena cava(IVC) diameter and collapsibility. Later, out of nine POCUS diagnosis defined in the study algorithm patients were treated and compared with final hospital diagnosis to estimate the accuracy of this strategy.

Results: ED diagnosis of dyspnea using the diagnostic strategy proposed in the study was in compliance with final hospital diagnosis with high agreement in 86% of patients with Kappa statistic = 0.798 (p<0.001) which is statisticaly significant.Acute decompensated heart failure (ADHF) was the most common diagnosis. 98.69% and 96.23% was the sensitivity and specificity of the diagnostic strategy used in this study to identify ADHF. A significant (p<0.01) proportion of patients presenting with dyspnea had Presence of ARDS with ADHF. 

Conclusion:Incorporating POCUS by lung-cardiac-IVC into routine clinical evaluation yielded a higher accuracy in differentiating causes of dyspnea in ED, and hence this diagnostic strategy could be recommended even in resource-limited setting.