Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Emerg Med. 2021 Aug;61(2):161-168. doi: 10.1016/j.jemermed.2021.02.019. Epub 2021 Mar 29.
Acute heart failure and exacerbation of chronic obstructive pulmonary disease (COPD) are sometimes difficult to differentiate in the emergency department (ED).
We sought to determine the classification performance of lung point-of-care ultrasound (POCUS) compared with chest x-ray study to identify acute heart failure in an older population.
We conducted a cohort study with additional health records review between March and September 2017. We included consecutive patients aged 50 years and older with shortness of breath from suspected acute heart failure or COPD. The reference standard was discharged diagnosis, ED diagnosis with confirmation by another physician, or diagnosis made by health record reviews. We calculated the classification performance of lung POCUS to diagnose acute heart failure as well as that of chest x-ray study, and compared them by exact McNemar test.
There were 81 patients evaluated with lung POCUS, and 67 had acute heart failure. Emergency physicians identified acute heart failure by lung POCUS with sensitivity of 92.5% (95% confidence interval [CI] 83.4-97.5%) and specificity of 85.7% (95% CI 57.2-98.2%). The radiology reading of chest x-ray study had sensitivity of 63.6% (95% CI 50.9-75.1%) and specificity of 92.9% (95% CI 66.1-99.8%). The sensitivity of lung POCUS was significantly higher than that of chest x-ray study (p = 0.0003).
Lung POCUS in a real clinical setting was highly sensitive and specific in identifying acute heart failure, and performed better than chest x-ray in an older population.
在急诊科（ED），急性心力衰竭和慢性阻塞性肺疾病（COPD）恶化有时难以区分。
我们旨在确定肺部即时超声（POCUS）与胸部 X 线检查相比在识别老年人群中急性心力衰竭的分类性能。
我们进行了一项队列研究，并在 2017 年 3 月至 9 月期间进行了额外的健康记录回顾。我们纳入了因疑似急性心力衰竭或 COPD 而出现呼吸急促的年龄在 50 岁及以上的连续患者。参考标准是出院诊断、由另一名医生确认的 ED 诊断或通过健康记录回顾做出的诊断。我们计算了肺部 POCUS 诊断急性心力衰竭的分类性能，以及胸部 X 线检查的分类性能，并通过精确的 McNemar 检验对其进行了比较。
有 81 例患者接受了肺部 POCUS 评估，其中 67 例患有急性心力衰竭。急诊医师通过肺部 POCUS 诊断急性心力衰竭的敏感性为 92.5%（95%置信区间 [CI] 83.4-97.5%），特异性为 85.7%（95% CI 57.2-98.2%）。胸部 X 线检查的放射科阅读的敏感性为 63.6%（95% CI 50.9-75.1%），特异性为 92.9%（95% CI 66.1-99.8%）。肺部 POCUS 的敏感性明显高于胸部 X 线检查（p=0.0003）。
在真实临床环境中，肺部 POCUS 对识别急性心力衰竭具有高度敏感性和特异性，并且在老年人群中的表现优于胸部 X 线检查。
