Novice point-of-care ultrasound for the assessment of acute dyspnea in the emergency department.

BACKGROUND: Dyspnea is one of the most common presentations to the ED. The goal of this study was to determine the diagnostic accuracy of POCUS examination completed by a medical student for several causes of dyspnea. METHODS: A prospective observational study was conducted in the ED of an academic center. Adult patients (≥ 18 yo) who presented to the emergency room with dyspnea were enrolled in the study. The study investigator was a medical student who was blinded to the clinical work up. Standardized POCUS examinations were performed following a modified BLUE protocol to identify the dyspnea etiology as one of the following diagnoses: asthma/COPD, acute heart failure, pneumonia, pulmonary embolism, pneumothorax, and non-diagnostic. POCUS diagnoses were compared to the clinical diagnosis made by the treating emergency physician. RESULTS: 250 patients were enrolled in the study. 99 (39.6%) patients were male, and 136 (54.4%) patients identified as Black. POCUS demonstrated high sensitivity and specificity for diagnosing asthma/COPD, acute heart failure, pneumonia, and pneumothorax. Concordance was optimal (0.8 < k < 1) for the diagnosis of asthma/COPD, acute decompensated heart failure; good (0.6 < k < 0.8) for pneumonia and non-diagnostic; and moderate (0.4 < k < 0.6) for pneumothorax and pulmonary embolism. Overall concordance was optimal (k = 0.84). CONCLUSION: POCUS examinations completed by a medical student demonstrated acceptable diagnostic accuracy for asthma/COPD, acute heart failure, and pneumonia. Medical student POCUS examinations could be used for risk stratification to identify patients that require additional diagnostic imaging.