Diagnosing acute heart failure in patients with undifferentiated dyspnea: A lung and cardiac ultrasound (LuCUS) protocol

Frances Russell, Robert R. Ehrman, Karen Cosby, Asim Ansari, Stephanie Tseeng, Errick Christain, John Bailitz

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objectives The primary goal of this study was to determine accuracy for diagnosing acutely decompensated heart failure (ADHF) in the undifferentiated dyspneic emergency department (ED) patient using a lung and cardiac ultrasound (LuCUS) protocol. Secondary objectives were to determine if US findings acutely change management and if findings are more accurate than clinical gestalt. Methods This was a prospective, observational study of adult patients presenting to the ED with undifferentiated dyspnea. The intervention consisted of a 12-view LuCUS protocol performed by experienced emergency physician sonographers. The primary objective was measured by comparing US findings to the final diagnosis independently determined by two physicians blinded to the LuCUS result. Acute treatment changes based on US findings were tracked in real time through a standardized data collection form. Results Data on 99 patients were analyzed; ADHF was the final diagnosis in 36%. The LuCUS protocol had sensitivity of 83% (95% confidence interval [CI] = 67% to 93%), specificity of 83% (95% CI = 70% to 91%), positive likelihood ratio of 4.8 (95% CI = 2.7 to 8.3), and negative likelihood ratio of 0.20 (95% CI = 0.09 to 0.42). Forty-seven percent of patients had changes in acute management, and 42% had changes in acute treatment. Observed agreement for the LuCUS protocol was 93% between coinvestigators. Overall, accuracy improved by 20% (83% vs. 63%, 95% CI = 8% to 31% for the difference) over clinical gestalt alone. Conclusions The LuCUS protocol may accurately identify ADHF and may improve acute clinical management in dyspneic ED patients. This protocol has improved diagnostic accuracy over clinical gestalt alone.

Original languageEnglish (US)
Pages (from-to)182-191
Number of pages10
JournalAcademic Emergency Medicine
Volume22
Issue number2
DOIs
StatePublished - Feb 1 2015

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Dyspnea
Heart Failure
Lung
Confidence Intervals
Hospital Emergency Service
Physicians
Observational Studies
Emergencies
Prospective Studies
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Diagnosing acute heart failure in patients with undifferentiated dyspnea : A lung and cardiac ultrasound (LuCUS) protocol. / Russell, Frances; Ehrman, Robert R.; Cosby, Karen; Ansari, Asim; Tseeng, Stephanie; Christain, Errick; Bailitz, John.

In: Academic Emergency Medicine, Vol. 22, No. 2, 01.02.2015, p. 182-191.

Research output: Contribution to journalArticle

Russell, Frances ; Ehrman, Robert R. ; Cosby, Karen ; Ansari, Asim ; Tseeng, Stephanie ; Christain, Errick ; Bailitz, John. / Diagnosing acute heart failure in patients with undifferentiated dyspnea : A lung and cardiac ultrasound (LuCUS) protocol. In: Academic Emergency Medicine. 2015 ; Vol. 22, No. 2. pp. 182-191.
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abstract = "Objectives The primary goal of this study was to determine accuracy for diagnosing acutely decompensated heart failure (ADHF) in the undifferentiated dyspneic emergency department (ED) patient using a lung and cardiac ultrasound (LuCUS) protocol. Secondary objectives were to determine if US findings acutely change management and if findings are more accurate than clinical gestalt. Methods This was a prospective, observational study of adult patients presenting to the ED with undifferentiated dyspnea. The intervention consisted of a 12-view LuCUS protocol performed by experienced emergency physician sonographers. The primary objective was measured by comparing US findings to the final diagnosis independently determined by two physicians blinded to the LuCUS result. Acute treatment changes based on US findings were tracked in real time through a standardized data collection form. Results Data on 99 patients were analyzed; ADHF was the final diagnosis in 36{\%}. The LuCUS protocol had sensitivity of 83{\%} (95{\%} confidence interval [CI] = 67{\%} to 93{\%}), specificity of 83{\%} (95{\%} CI = 70{\%} to 91{\%}), positive likelihood ratio of 4.8 (95{\%} CI = 2.7 to 8.3), and negative likelihood ratio of 0.20 (95{\%} CI = 0.09 to 0.42). Forty-seven percent of patients had changes in acute management, and 42{\%} had changes in acute treatment. Observed agreement for the LuCUS protocol was 93{\%} between coinvestigators. Overall, accuracy improved by 20{\%} (83{\%} vs. 63{\%}, 95{\%} CI = 8{\%} to 31{\%} for the difference) over clinical gestalt alone. Conclusions The LuCUS protocol may accurately identify ADHF and may improve acute clinical management in dyspneic ED patients. This protocol has improved diagnostic accuracy over clinical gestalt alone.",
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