Point-of-care lung ultrasound - a rapid and reliable diagnostic tool for emergency physicians treating patients with acute dyspnea in high-volume emergency departments.

Purpose: Acute dyspnea is a common presenting symptom in the Emergency Department (ED). The study aims to assess the concordance between emergency physician diagnosis (i.e., initial rapid assessment at ED admission including point-of-care lung ultrasound - PoC-LUS) and attending physician diagnosis (i.e., hospital admission diagnosis which also includes CT scans) in patients presenting with dyspnea.

Method: We performed a prospective pilot observational study in the ED of tertiary care university hospital between 31.01.2022 and 03.09.2024. We included dyspneic patients presented when the physician involved in the study was on call.

Results: A total of 103 patients were included (mean age, 70±16.1 years). An excellent agreement was found between emergency physician and attending physician diagnosis for all etiologies of dyspnea: pleural effusion (Cohen's kappa coefficient 1 for bilateral, 0.844 for right, 0.790 for left pleural effusion), pneumonia (κ = 0.979 for right, κ = 0.930 for left pneumonia), bronchopneumonia (κ = 0.912), acute pulmonary edema (κ = 1), chronic obstructive pulmonary disease exacerbation (κ = 0.904), pleuropulmonary tumors (k = 0.884), acute respiratory distress syndrome - ARDS (κ = 1), (p < 0.001 for all). The median(±SD) time needed to complete the emergency physician diagnosis was 16(±4) minutes and the median(±SD) time needed to complete the attending physician diagnosis was 480(±112) minutes.

Conclusion: In patients presenting in the ED with dyspnea, PoC-LUS guided emergency physician diagnosis has a very good diagnosis performance. The time needed to complete the emergency physician diagnosis is much lower than the time needed to complete the attending physician diagnosis. Given its availability, PoC-LUS is a useful tool for the assessment of patients presenting with dyspnea.