Markarian Thibaut, Zieleskiewicz Laurent, Perrin Gilles, Claret Pierre-Géraud, Loundou Anderson, Michelet Pierre, Bobbia Xavier
*Department of Emergency Medicine and Intensive Care,Timone University Hospital,Marseille,France.
†Department of Anesthesiology and Intensive Care,North Hospital,APHM,Aix-Marseille University,Marseille,France.
CJEM. 2019 May;21(3):399-405. doi: 10.1017/cem.2018.483. Epub 2019 Jan 25.
Lung ultrasound has value in diagnosing dyspnea. The main objective of this study was to evaluate the accuracy of a modified lung ultrasound (MLUS) score to predict the severity of acute dyspnea in elderly patients.
This was an observational single-centre study including patients over age 64 admitted to the emergency department for acute dyspnea with hypoxia. Participants had an early lung ultrasound performed by a dedicated emergency physician, followed by the usual care by a team blinded to the lung ultrasound results. Patients were allocated by disposition to either a critical care (CC) group (patients who needed admission to the intensive care unit [ICU] and/or who died within 48 h) or a standard care group.
Among 137 patients analysed (mean age 79 ± 13 years, 74 [54%] women), 43 (31%) were categorized into the CC group. The time taken to obtain the MLUS was 30 ± 22 min. The area under the receiver operating characteristic curve of the MLUS for predicting the CC group was 0.97 (0.92-0.99; p < 0.01) with a cut-off set strictly above 17 for 93% sensitivity (81-99), 99% specificity (94-100), a positive predictive value of 98% (87-100), a negative predictive value of 97% (91-99), a positive likelihood ratio of 86, a negative likelihood ratio of 0.07, and a diagnostic accuracy of 97% (93-99). In a multivariate analysis, the MLUS was the only independent associated factor for the CC group.
An early lung ultrasound score can predict the need for ICU admission and/or death within 48 hours in elderly dyspneic patients.
肺部超声在诊断呼吸困难方面具有价值。本研究的主要目的是评估改良肺部超声（MLUS）评分预测老年患者急性呼吸困难严重程度的准确性。
这是一项单中心观察性研究，纳入了因急性呼吸困难伴低氧血症而入住急诊科的64岁以上患者。参与者由一名专门的急诊科医生进行早期肺部超声检查，随后由对肺部超声结果不知情的团队进行常规护理。患者根据处置情况被分配到重症监护（CC）组（需要入住重症监护病房[ICU]和/或在48小时内死亡的患者）或标准护理组。
在分析的137例患者中（平均年龄79±13岁，74例[54%]为女性），43例（31%）被归入CC组。获取MLUS的时间为30±22分钟。MLUS预测CC组的受试者工作特征曲线下面积为0.97（0.92 - 0.99；p＜0.01），临界值严格设定在17以上，敏感性为93%（81 - 99），特异性为99%（94 - 100），阳性预测值为98%（87 - 100），阴性预测值为97%（91 - 99），阳性似然比为86，阴性似然比为0.07，诊断准确性为97%（93 - 99）。在多变量分析中，MLUS是CC组唯一的独立相关因素。
早期肺部超声评分可预测老年呼吸困难患者在48小时内入住ICU和/或死亡的需求。
