A Modified Lung and Cardiac Ultrasound Protocol Saves Time and Rules in the Diagnosis of Acute Heart Failure

Frances Russell, Robert R. Ehrman

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Multiorgan ultrasound (US), which includes evaluation of the lungs and heart, is an accurate method that outperforms clinical gestalt for diagnosing acutely decompensated heart failure (ADHF). A known barrier to ultrasound use is the time needed to perform these examinations. Objective: The primary goal of this study was to determine the test characteristics of a modified lung and cardiac US (LuCUS) protocol for the accurate diagnosis of ADHF. Methods: This was a secondary analysis of a prospective observational study that enrolled adult patients presenting to the emergency department with undifferentiated dyspnea. Intervention consisted of a modified LuCUS protocol performed by experienced emergency physician sonographers. A positive modified LuCUS protocol was defined as the presence of B+ lines in both the left and right anterosuperior lung zones, plus a left ventricular ejection fraction <45%. If all three of these findings were not present, the modified LuCUS result was interpreted as negative for ADHF. The primary objective was measured by comparing US findings to final diagnosis independently determined by two physicians, both blinded to US findings and each other's final diagnosis. Results: We analyzed data on 99 patients; 36% had a final diagnosis of ADHF. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the modified LuCUS protocol are 25% (95% confidence interval [CI] 14-41%), 100% (95% CI 94-100%), undefined, and 0.75 (95% CI 0.62-0.91%), respectively. This modified protocol takes on average 1 min and 32 sec to complete. Conclusion: The point estimate for the specificity of the modified LuCUS protocol in this pilot study, accomplished by a reanalysis of data collected for a previously reported investigation of the full LuCUS protocol, was 100% for the diagnosis of ADHF.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StateAccepted/In press - Nov 26 2016

Fingerprint

Heart Failure
Lung
Confidence Intervals
Physicians
Stroke Volume
Dyspnea
Observational Studies
Hospital Emergency Service
Emergencies
Prospective Studies
Sensitivity and Specificity

Keywords

  • Acute heart failure
  • Bedside ultrasound
  • Cardiac ultrasound
  • Clinical ultrasound
  • Diagnosis
  • Emergency ultrasound
  • Lung ultrasound
  • Multiorgan ultrasound
  • Undifferentiated dyspnea

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{0aa763c3d1cf400fa48ed2722a9770c1,
title = "A Modified Lung and Cardiac Ultrasound Protocol Saves Time and Rules in the Diagnosis of Acute Heart Failure",
abstract = "Background: Multiorgan ultrasound (US), which includes evaluation of the lungs and heart, is an accurate method that outperforms clinical gestalt for diagnosing acutely decompensated heart failure (ADHF). A known barrier to ultrasound use is the time needed to perform these examinations. Objective: The primary goal of this study was to determine the test characteristics of a modified lung and cardiac US (LuCUS) protocol for the accurate diagnosis of ADHF. Methods: This was a secondary analysis of a prospective observational study that enrolled adult patients presenting to the emergency department with undifferentiated dyspnea. Intervention consisted of a modified LuCUS protocol performed by experienced emergency physician sonographers. A positive modified LuCUS protocol was defined as the presence of B+ lines in both the left and right anterosuperior lung zones, plus a left ventricular ejection fraction <45{\%}. If all three of these findings were not present, the modified LuCUS result was interpreted as negative for ADHF. The primary objective was measured by comparing US findings to final diagnosis independently determined by two physicians, both blinded to US findings and each other's final diagnosis. Results: We analyzed data on 99 patients; 36{\%} had a final diagnosis of ADHF. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the modified LuCUS protocol are 25{\%} (95{\%} confidence interval [CI] 14-41{\%}), 100{\%} (95{\%} CI 94-100{\%}), undefined, and 0.75 (95{\%} CI 0.62-0.91{\%}), respectively. This modified protocol takes on average 1 min and 32 sec to complete. Conclusion: The point estimate for the specificity of the modified LuCUS protocol in this pilot study, accomplished by a reanalysis of data collected for a previously reported investigation of the full LuCUS protocol, was 100{\%} for the diagnosis of ADHF.",
keywords = "Acute heart failure, Bedside ultrasound, Cardiac ultrasound, Clinical ultrasound, Diagnosis, Emergency ultrasound, Lung ultrasound, Multiorgan ultrasound, Undifferentiated dyspnea",
author = "Frances Russell and Ehrman, {Robert R.}",
year = "2016",
month = "11",
day = "26",
doi = "10.1016/j.jemermed.2017.02.003",
language = "English (US)",
journal = "Journal of Emergency Medicine",
issn = "0736-4679",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - A Modified Lung and Cardiac Ultrasound Protocol Saves Time and Rules in the Diagnosis of Acute Heart Failure

AU - Russell, Frances

AU - Ehrman, Robert R.

PY - 2016/11/26

Y1 - 2016/11/26

N2 - Background: Multiorgan ultrasound (US), which includes evaluation of the lungs and heart, is an accurate method that outperforms clinical gestalt for diagnosing acutely decompensated heart failure (ADHF). A known barrier to ultrasound use is the time needed to perform these examinations. Objective: The primary goal of this study was to determine the test characteristics of a modified lung and cardiac US (LuCUS) protocol for the accurate diagnosis of ADHF. Methods: This was a secondary analysis of a prospective observational study that enrolled adult patients presenting to the emergency department with undifferentiated dyspnea. Intervention consisted of a modified LuCUS protocol performed by experienced emergency physician sonographers. A positive modified LuCUS protocol was defined as the presence of B+ lines in both the left and right anterosuperior lung zones, plus a left ventricular ejection fraction <45%. If all three of these findings were not present, the modified LuCUS result was interpreted as negative for ADHF. The primary objective was measured by comparing US findings to final diagnosis independently determined by two physicians, both blinded to US findings and each other's final diagnosis. Results: We analyzed data on 99 patients; 36% had a final diagnosis of ADHF. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the modified LuCUS protocol are 25% (95% confidence interval [CI] 14-41%), 100% (95% CI 94-100%), undefined, and 0.75 (95% CI 0.62-0.91%), respectively. This modified protocol takes on average 1 min and 32 sec to complete. Conclusion: The point estimate for the specificity of the modified LuCUS protocol in this pilot study, accomplished by a reanalysis of data collected for a previously reported investigation of the full LuCUS protocol, was 100% for the diagnosis of ADHF.

AB - Background: Multiorgan ultrasound (US), which includes evaluation of the lungs and heart, is an accurate method that outperforms clinical gestalt for diagnosing acutely decompensated heart failure (ADHF). A known barrier to ultrasound use is the time needed to perform these examinations. Objective: The primary goal of this study was to determine the test characteristics of a modified lung and cardiac US (LuCUS) protocol for the accurate diagnosis of ADHF. Methods: This was a secondary analysis of a prospective observational study that enrolled adult patients presenting to the emergency department with undifferentiated dyspnea. Intervention consisted of a modified LuCUS protocol performed by experienced emergency physician sonographers. A positive modified LuCUS protocol was defined as the presence of B+ lines in both the left and right anterosuperior lung zones, plus a left ventricular ejection fraction <45%. If all three of these findings were not present, the modified LuCUS result was interpreted as negative for ADHF. The primary objective was measured by comparing US findings to final diagnosis independently determined by two physicians, both blinded to US findings and each other's final diagnosis. Results: We analyzed data on 99 patients; 36% had a final diagnosis of ADHF. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the modified LuCUS protocol are 25% (95% confidence interval [CI] 14-41%), 100% (95% CI 94-100%), undefined, and 0.75 (95% CI 0.62-0.91%), respectively. This modified protocol takes on average 1 min and 32 sec to complete. Conclusion: The point estimate for the specificity of the modified LuCUS protocol in this pilot study, accomplished by a reanalysis of data collected for a previously reported investigation of the full LuCUS protocol, was 100% for the diagnosis of ADHF.

KW - Acute heart failure

KW - Bedside ultrasound

KW - Cardiac ultrasound

KW - Clinical ultrasound

KW - Diagnosis

KW - Emergency ultrasound

KW - Lung ultrasound

KW - Multiorgan ultrasound

KW - Undifferentiated dyspnea

UR - http://www.scopus.com/inward/record.url?scp=85014694848&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014694848&partnerID=8YFLogxK

U2 - 10.1016/j.jemermed.2017.02.003

DO - 10.1016/j.jemermed.2017.02.003

M3 - Article

C2 - 28285867

AN - SCOPUS:85014694848

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

SN - 0736-4679

ER -