Point-of-care Ultrasound and Dyspnea in the Emergency Department

Abstract

Dyspnea causes one in ten visits to the emergency department (ED), and half of the patients
require hospitalization for 2 to 7 days. Discharge diagnoses commonly include ‘Dyspnea - not
otherwise specified’, chronic obstructive pulmonary disease, pneumonia, heart failure,
pulmonary embolism, and asthma. One out of twenty patients dies during hospitalization,
and one in ten dies within 30 days after discharge. Point-of-care ultrasound (POCUS) plays an
increasing role in the initial diagnostic work-up of these patients and can help diagnose
several of the common conditions causing the dyspnea. Despite its everyday occurrence,
surprisingly little is known about how the diagnostic work contributes to the health of the
patients, and the adoption of POCUS, in this regard, tends to vary considerably between
physicians.
The studies in this PhD dissertation aimed to further understand whether a point-of-care
ultrasound-driven diagnostic pathway compared to a usual diagnostic pathway improves and
simplifies healthcare processes for emergency department patients with dyspnea.
Study I mapped the current evidence of point-of-care lung ultrasound in emergency medicine,
with an emphasis on study designs and primary outcomes. Through a systematic literature
search, study selection, and extraction process, the key features of 406 relevant papers were
displayed in an interactive online database. Overall, few randomized controlled trials had
been conducted, and the majority of studies had primarily explored diagnostic accuracy
research questions.
Study II randomized 674 adult ED patients with dyspnea as chief complaint to either a POCUSdriven
diagnostic pathway or a usual diagnostic pathway without in-ED focused lung and
cardiac ultrasound. The intervention was not found to affect the hospital length of stay,
including the primary outcome, alive and discharged within 24 hours. However, it reduced
the utilization of chest X-rays and accelerated the physician’s perceived diagnostic certainty.
Overall, the studies support and further justify POCUS's current role in the diagnostic workup
of ED patients with dyspnea.