CHest PHysical Exam with UltraSound (CHEPHEUS) part 2. A pilot study

<bold>Introduction:</bold> The applications of chest ultrasound (US) are progressively increasing. The US technical equipment has become even more portable mantaining a good imaging quality, so that every respiratory physician could dispose of a personal US device pontentially useful in clinical practice. After a survey (CHEPHEUS1, under publication) in which the potential impact of US used during physical examination (PE) was investigated, the aim of this study is to assess the role of US added routinely to the traditional PE and its impact on clnician's diagnostic ability. <bold>Methods:</bold> This is a multicenter study to assess the impact of a chest US examination following the normal chest PE, in terms of time spent in performing US, difference in number of clinical hypothesis before and after US, the finding with US of eventual false negative PEs. <bold>Results:</bold> 4 centers collected data of 55 outpatients visits. The average duration of US was 156±84 seconds. 12 visits had the aim to exclude diseases and confirm normality. 43 visits aimed to find a disease in symptomatic patients. The median number of clinical hypothesis before and after US was respectively 2 and 1, the paired t test showed a significative reduction of clinical hypothesis after US (p<0.0001). 10 out of 18 (55%) normal PE showed a pathological US, 8 of 18 (45%) were confirmed as normal. In 11 visits out of 55 (20%) the final diagnosis was totally changed by US. <bold>Conclusions:</bold> Our data showed that routinely adding US after PE could significatively reduce the number of clinical hypothesis, discover false negatives of PE and often change the diagnosis, with a negligible impact on examination time. A larger study is to be planned to confirm this data.