Efficacy of thoracic ultrasound in patients presenting to the emergency department with shortness of breath

Efficacy of Thoracic Ultrasound in Patients Presenting to the Emergency Department with Shortness of Breath Objective: Shortness of breath is a common complaint among emergency department admissions. Recently bedside ultrasound imaging has been used to make the differential diagnosis accurate and fast. The use areas of ultrasound are constantly expanding, due to the fact that it is a cheap, easily accessible, and fast test. The aim of this study was to evaluate the efficacy of bedside lung ultrasound in early diagnosis and treatment of respiratory distress in emergency patients . Material and Method: This prospective study was started after receiving ethics board approval, and 120 patients who were admitted to Cukurova University Emergency Department Adult Emergency Clinic with the complaints of shortness of breath between November 2017 and January 2019 were included in the study. BLUE protocol was used for the standardization of ultrasonographic evaluation and a standard research form was used for the study. For each patient, lung ultrasonographic imaging was performed on the right and left hemithorax at the points indicated in the BLUE protocol. Pleural slip motion, A lines, B lines, consolidation, effusion, barcode findings were evaluated individually. In addition, age, gender, underlying diseases, other radiological findings, laboratory findings, final clinical diagnosis and admission and discharge status were recorded in the evaluation form. Statistical analysis of the study was performed by entering the data obtained to the SPSS program. Findings: A total of 120 patients, 77 (64.2%) male and 43 (35.8%) female, were included in the study. When the ultrasonographic evaluation findings of the patients according to BLUE protocol algorithm were taken into consideration, the rate of patients with pleural gliding motion was 92.5% (n = 111), with the presence of A lines was 75.8% (n = 91), with the presence of B lines was 42%, those with consolidation was 40.0% (n = 48), the rate of effusion was 10.0% (n = 12) and the rate of those with barcode finding was 4.2% (n = 5). Ultrasound findings were compared with the final diagnoses using the kappa compliance analysis test for statistical analysis of lung ultrasound. There was an agreement in the diagnosis of pneumonia and the consolidation in the ultrasound (p <0.001), the diagnosis of pulmonary edema and B lines present in the ultrasound (p <0.001), the diagnosis of pneumothorax and the barcode sign of the lung (p <0.001), the diagnosis of pleural effusion in those with pleural effusion (p <0.001), and it was found to be statistically significant. According to the presence of ultrasound consolidation, the sensitivity in diagnosis of pneumonia was 66.6%, specificity was 100%; sensitivity in the diagnosis of pulmonary edema was 100%, specificity was 83.1%; both sensitivity and specificity in the diagnosis of pneumothorax was 100%. Conclusion: Ultrasound is superior to chest radiography in the diagnosis of pneumonia, pulmonary edema, pleavral effusion, and especially in pneumothorax; it can be especially useful in the initial diagnosis. Also, it is useful to use ultrasound as a part of the diagnostic approach because it does not contain radiation, it can be used in pregnant women, it is portable and can give fast results. Keywords: Emergency medicine, BLUE Protocol, Shortness of Breath, Lung Ultrasonographic Evaluation