Chest
Original ResearchPulmonary Vascular DiseaseLung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED
Section snippets
Study Design
This was a prospective, observational, multicenter, cohort study conducted in seven Italian EDs (two academic, one university-affiliated, and four community hospitals). Patients were enrolled from October 2010 to September 2012; each center recruited for a 6-month period. The protocol was approved by the institutional review board of the “Città della Salute e della Scienza di Torino” Hospital (project approval number 2CEI-105/0068893) and by the institutional review boards of the other
Patients
Of 1,007 patients eligible for this study, two denied consent to enrollment; therefore, 1,005 patients were included in the analyses. Of these, 544 (54.1%) were enrolled in community hospitals and 461 (45.9%) in academic or university-affiliated centers. Sixty-two emergency physicians participated in the study, each enrolling a median number of 44 patients (IQR, 22).
Final diagnosis was ADHF for 463 patients (46%) and noncardiac dyspnea for 542 (54%). Interrater agreement between the two expert
Discussion
In this study, we found that, in adult subjects with acute dyspnea in the ED, a LUS-implemented approach had higher diagnostic accuracy than other commonly used diagnostic tools (ie, initial clinical workup, CXR, LUS alone, and BNP/NT-pro-BNP levels) in differentiating ADHF from noncardiac causes of acute dyspnea. To overcome LUS limitations in ADHF diagnosis,1, 6, 35, 36 we adopted an integrated approach that paired LUS with the pretest probability of the clinical assessment. Moreover, we
Acknowledgments
Author contributions: E. P., A. G., E. L., F. M., and G. A. C. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. E. P. served as principal author. E. P., A. G., E. L., M. M. M., I. B., F. M., and G. A. C. contributed to the study concept; E. P., A. G., E. L., M. T., G. P., E. F., G. V., P. B., A. B., A. I., S. L., G. C., M. M. M., F. M., and G. A. C. contributed to the study design and data acquisition;
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Partial data from this study were presented at the European Society of Cardiology 2013 Annual Meeting, August 31-September 4, 2013, Amsterdam, The Netherlands; American College of Emergency Physicians 2012 Scientific Assembly, October 8-11, 2012, Denver, CO; and the American Institute of Ultrasound in Medicine 2013 Annual Meeting, April 7-11, 2013, New York, NY.
FUNDING/SUPPORT: The authors have reported to that no funding was received for this study.
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