Kowalczyk Damian, Turkowiak Miłosz, Piotrowski Wojciech Jerzy, Rosiak Oskar, Białas Adam Jerzy
Department of Pneumology, 2nd Chair of Internal Medicine, Medical University of Lodz, 90-419 Lodz, Poland.
Department of Anesthesiology and Intensive Care, National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland.
Diagnostics (Basel). 2023 Nov 9;13(22):3412. doi: 10.3390/diagnostics13223412.
Lung transthoracic ultrasound (LUS) is an accessible and widely applicable method of rapidly imaging certain pathologies in the thorax. LUS proves to be an optimal tool in respiratory emergency medicine, applicable in various clinical settings. However, despite the rapid development of bedside ultrasonography, or point-of-care (POCUS) ultrasound, there remains a scarcity of knowledge about the use of LUS in pre-hospital settings. Therefore, our aim was to assess the usefulness of LUS as an additional tool in diagnosing dyspnea when performed by experienced paramedics in real-life, pre-hospital settings. Participants were recruited consecutively among patients who called for an emergency due to dyspnea in the Warsaw region of Poland. All the enrolled patients were admitted to the Emergency Department (ED). In the prehospital setting, a paramedic experienced in LUS conducted an ultrasonographic examination of the thorax, including Bedside Lung Ultrasound in Emergency (BLUE) and extended Focused Assessment with Sonography for Trauma (eFAST) protocols. The paramedic's diagnosis was compared to the ED diagnosis, and if available, to the final diagnosis established on the day of discharge from the hospital. We enrolled 44 patients in the study, comprising 22 (50%) men and (50%) women with a median age of 76 (IQR: 69.75-84.5) years. The LUS performed by paramedic was concordant with the discharge diagnosis in 90.91% of cases, where the final diagnosis was established on the day of discharge from the hospital. In cases where the patient was treated only in the ED, the pre-hospital LUS was concordant with the ED diagnosis in 88.64% of cases. The mean time of the LUS examination was 63.66 s (SD: 19.22). The inter-rater agreement between the pre-hospital diagnosis and ER diagnosis based on pre-hospital LUS and complete ER evaluation was estimated at k = 0.822 (SE: 0.07; 95%CI: 0.68, 0.96), indicating strong agreement, and between the pre-hospital diagnosis based on LUS and final discharge diagnosis, it was estimated at k = 0.934 (SE: 0.03; 95%CI: 0.88, 0.99), indicating almost perfect agreement. In conclusion, paramedic-acquired LUS seems to be a useful tool in the pre-hospital differential diagnosis of dyspnea in adults.
肺部经胸超声检查（LUS）是一种可及且广泛适用的方法，能够快速对胸部的某些病变进行成像。LUS被证明是呼吸急诊医学中的一种理想工具，适用于各种临床场景。然而，尽管床边超声检查，即床旁即时超声检查（POCUS）发展迅速，但关于LUS在院前环境中的应用，仍缺乏相关知识。因此，我们的目的是评估在现实生活中的院前环境中，由经验丰富的护理人员进行LUS检查作为诊断呼吸困难的辅助工具的实用性。连续招募在波兰华沙地区因呼吸困难呼叫急救的患者。所有入选患者均被收入急诊科（ED）。在院前环境中，一名精通LUS的护理人员对胸部进行超声检查，包括急诊床边肺部超声（BLUE）和扩展创伤超声重点评估（eFAST）方案。将护理人员的诊断与ED诊断进行比较，并在可行的情况下，与出院当天确定的最终诊断进行比较。我们共纳入44例患者进行研究，其中男性22例（50%），女性22例（50%），中位年龄为76岁（四分位间距：69.75 - 84.5岁）。护理人员进行的LUS检查在90.91%的病例中与出院诊断一致，出院诊断于出院当天确定。在仅在ED接受治疗的患者中，院前LUS检查在88.64%的病例中与ED诊断一致。LUS检查的平均时间为63.66秒（标准差：19.22）。基于院前LUS检查的院前诊断与急诊全面评估后的急诊诊断之间的评分者间一致性估计为k = 0.822（标准误：0.07；95%置信区间：0.68，0.96），表明一致性较强；基于LUS的院前诊断与最终出院诊断之间的一致性估计为k = 0.934（标准误：0.03；95%置信区间：0.88，0.99），表明几乎完全一致。总之，护理人员进行的LUS检查似乎是成人院前呼吸困难鉴别诊断的一种有用工具。
