Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED

Chest. 2017 Jun;151(6):1295-1301. doi: 10.1016/j.chest.2017.02.003. Epub 2017 Feb 16.


Background: Acute dyspnea is a common symptom in the ED. The standard approach to dyspnea often relies on radiologic and laboratory results, causing excessive delay before adequate therapy is started. Use of an integrated point-of-care ultrasonography (PoCUS) approach can shorten the time needed to formulate a diagnosis, while maintaining an acceptable safety profile.

Methods: Consecutive adult patients presenting with dyspnea and admitted after ED evaluation were prospectively enrolled. The gold standard was the final diagnosis assessed by two expert reviewers. Two physicians independently evaluated the patient; a sonographer performed an ultrasound evaluation of the lung, heart, and inferior vena cava, while the treating physician requested traditional tests as needed. Time needed to formulate the ultrasound and the ED diagnoses was recorded and compared. Accuracy and concordance of the ultrasound and the ED diagnoses were calculated.

Results: A total of 2,683 patients were enrolled. The average time needed to formulate the ultrasound diagnosis was significantly lower than that required for ED diagnosis (24 ± 10 min vs 186 ± 72 min; P = .025). The ultrasound and the ED diagnoses showed good overall concordance (κ = 0.71). There were no statistically significant differences in the accuracy of PoCUS and the standard ED evaluation for the diagnosis of acute coronary syndrome, pneumonia, pleural effusion, pericardial effusion, pneumothorax, and dyspnea from other causes. PoCUS was significantly more sensitive for the diagnosis of heart failure, whereas a standard ED evaluation performed better in the diagnosis of COPD/asthma and pulmonary embolism.

Conclusions: PoCUS represents a feasible and reliable diagnostic approach to the patient with dyspnea, allowing a reduction in time to diagnosis. This protocol could help to stratify patients who should undergo a more detailed evaluation.

Keywords: dyspnea; emergency medicine; ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / diagnostic imaging
  • Aged
  • Aged, 80 and over
  • Asthma / complications
  • Asthma / diagnostic imaging
  • Dyspnea / diagnostic imaging*
  • Dyspnea / etiology
  • Emergency Service, Hospital
  • Female
  • Heart / diagnostic imaging*
  • Heart Diseases / complications
  • Heart Diseases / diagnostic imaging*
  • Heart Failure / complications
  • Heart Failure / diagnostic imaging
  • Humans
  • Lung / diagnostic imaging*
  • Lung Diseases / complications
  • Lung Diseases / diagnostic imaging*
  • Male
  • Middle Aged
  • Pericardial Effusion / complications
  • Pericardial Effusion / diagnostic imaging
  • Pleural Effusion / complications
  • Pleural Effusion / diagnostic imaging
  • Pneumonia / complications
  • Pneumonia / diagnostic imaging
  • Pneumothorax / complications
  • Pneumothorax / diagnostic imaging
  • Point-of-Care Systems
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / complications
  • Pulmonary Disease, Chronic Obstructive / diagnostic imaging
  • Pulmonary Embolism / complications
  • Pulmonary Embolism / diagnostic imaging
  • Time
  • Ultrasonography
  • Vena Cava, Inferior / diagnostic imaging*