Assessment of an Ultrasonography-Based Algorithm for Detecting the Causes of Acute Dyspnea in an Emergency Hospital

Objective: To investigate the value of point-of-care ultrasonography (POCUS) in identifying the causes of acute dyspnea (AD). Methods: In this prospective study, hospitalized adults with AD were enrolled. They underwent POCUS of the heart, lungs, and deep veins of the lower extremities, supplemented by lung auscultation (LA); all examinations were performed by an investigator blinded to the clinical diagnosis. The ultrasound profiles were compared with the clinical diagnoses to determine the diagnostic accuracy of the method. Results: A total of 150 patients, with a mean age of 65.8±15.7 years, were enrolled, and 53% were women. POCUS combined with LA showed a higher diagnostic accuracy [0.86 (95% confidence interval (CI), 0.81-0.91)] than POCUS alone [0.78 (95% CI, 0.72-0.84)]. The POCUS-based protocol showed the highest sensitivity for pleural effusion (1.0) and pericardial effusion [0.94 (95% CI, 0.81-1.00)], and the lowest sensitivity for pneumothorax (0.75 [95% CI, 0.20-1.00]) and pulmonary edema [0.78 (95% CI, 0.69-0.87)]. The examination duration was 12.5±3.9 min. Conclusions: The POCUS-based protocol was a rapid, informative tool for identifying the causes of AD in hospitalized adults, and the addition of LA further increased its diagnostic accuracy.