Msolli Mohamed Amine, Sekma Adel, Marzouk Maryem Ben, Chaabane Wael, Bel Haj Ali Khaoula, Boukadida Lotfi, Bzeouich Nasri, Gannoun Imen, Trabelssi Imen, Laaouiti Kamel, Grissa Mohamed Habib, Beltaief Kaouthar, Dridi Zohra, Belguith Asma, Methamem Mehdi, Bouida Wahid, Boukef Riadh, Boubaker Hamdi, Nouira Semir
Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.
Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
Ultrasound J. 2021 Feb 9;13(1):5. doi: 10.1186/s13089-021-00207-9.
Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea.
This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18 years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients' clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leading diagnosis was assessed by two expert sonographers, who were blinded to the residents' interpretations, based on clinical findings, chest X-ray, brain natriuretic peptide, cardiac and lung ultrasound testing. Accuracy and agreement of B-lines score and B-profile pattern were calculated.
We included 700 patients with a mean age of 68 ± 12.6 years and a sex ratio (M/F) of 1.43. The diagnosis of CHF was recorded in 371 patients (53%). The diagnostic performance of B-lines score at a cut-off 15 and B-profile pattern was, respectively, 88% and 82.5% for sensitivity, 75% and 84% for specificity, 80% and 85% for positive predictive value, 84% and 81% for negative predictive value. The area under receiver operating characteristic curve was 0.86 [0.83-0.89] and 0.83 [0.80-0.86], respectively, for B-lines score and B-profile pattern. There was an excellent agreement between residents for the diagnosis of CHF using both scores (kappa = 0.81 and 0.85, respectively, for ordinal scale B-lines score and B-profile pattern).
Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry: clinicaltrials.gov; Trial registration number: NCT03717779; Date of registration: October 24, 2018 'Retrospectively registered'; URL of trial registry record: clinicaltrials.gov.
超声B线最近已成为急诊科（ED）鉴别诊断急性呼吸困难的床旁成像工具。然而，尽管其操作简单，但肺部超声（LUS）尚未完全渗透到急诊科。本研究旨在评估急诊科（EM）住院医师进行的超声B线检查对因急性呼吸困难入住ED的患者诊断充血性心力衰竭（CHF）的准确性和可重复性。
这是一项于2016年1月至2017年10月进行的横断面前瞻性研究，纳入年龄超过18岁因急性呼吸困难入住ED的患者。入院时，由一对接受过2小时超声B线识别课程培训的EM住院医师连续进行两次床旁LUS检查，以独立确定B线评分和B型模式。所有参与的超声检查人员均对患者的临床数据不知情。B线评分≥15或B型模式被认为提示CHF。最终的主要诊断由两名专家超声检查人员根据临床表现、胸部X线、脑钠肽、心脏和肺部超声检查结果进行评估，他们对住院医师的解读不知情。计算B线评分和B型模式的准确性和一致性。
我们纳入了700例患者，平均年龄为68±12.6岁，男女比例（M/F）为1.43。371例患者（53%）被诊断为CHF。B线评分截断值为15时和B型模式的诊断性能分别为：敏感性88%和82.5%，特异性75%和84%，阳性预测值80%和85%，阴性预测值84%和81%。B线评分和B型模式的受试者操作特征曲线下面积分别为0.86[0.83 - 0.89]和0.83[0.80 - 0.86]。住院医师使用这两种评分诊断CHF的一致性非常好（B线评分和B型模式的有序量表kappa值分别为0.81和0.85）。
经过短期培训后，EM住院医师使用肺部超声B线评估诊断CHF具有良好的准确性和出色的可重复性。试验注册 注册机构名称：clinicaltrials.gov；试验注册号：NCT03717779；注册日期：2018年10月24日“回顾性注册”；试验注册记录的网址：clinicaltrials.gov。
