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Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis

  • Kyle McGivery (a1) (a2), Paul Atkinson (a1) (a2), David Lewis (a1) (a2), Luke Taylor (a1) (a2), Tim Harris (a3), Kathleen Gadd (a4), Jacqueline Fraser (a1) (a2) and George Stoica (a4)...

Abstract

Objectives

Dyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.

Methods

A systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.

Data Extraction and Synthesis

The search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).

Conclusions

Our results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.

Objectif

La dyspnée est un problème fréquent, difficile à diagnostiquer correctement par les médecins au service des urgences (SU). Certes, il existe un large éventail de diagnostics différentiels, mais l’insuffisance cardiaque décompensée aiguë (ICDA) est une cause fréquente de ce trouble, mais elle peut être difficile à distinguer d’autres causes. D’après des études récentes, l’échographie des poumons au SU pourrait jouer un rôle dans la pose du diagnostic. La revue systématique dont il sera question ici visait à évaluer l’exactitude de l’échographie précoce des poumons au chevet chez les patients souffrant de dyspnée au SU.

Méthode

La recherche consistait en une revue systématique des bases de données EMBASE, PubMed et Cochrane Library, de même qu’en un examen de la documentation parallèle. Nous avons procédé à une sélection des études prospectives qui faisaient état de la sensibilité et de la spécificité des lignes B observées à l’échographie précoce des poumons chez les patients souffrant de dyspnée au SU. Les études sélectionnées ont été soumises au questionnaire Critical Appraisal and Skills Program (CASP) en vue de l’évaluation de la qualité.

Extraction des données et synthèse

La recherche a permis de relever 3674 articles, dont 7 respectaient les critères de sélection ainsi que les exigences du questionnaire CASP, ce qui a porté à 1861 le nombre total de patients. Des statistiques sommaires provenant de la méta-analyse a révélé que l’échographie des poumons au chevet, en tant qu’examen de diagnostic de l’ICDA, avait une sensibilité globale de 82,5 % (intervalle de confiance [IC] à 95 % : 66,4 % à 91,8 %) et une spécificité globale de 83,6 % (IC à 95 % : 72,4 % à 90,8 %).

Conclusions

Les résultats de l’étude donnent à penser que l’échographie précoce des poumons en vue de la détection de lignes B chez les patients souffrant de dyspnée d’origine indéterminée au SU pourrait compléter, de manière fiable, les méthodes actuelles de diagnostic. L’intégration de l’échographie des poumons au SU pourrait donc faciliter et accélérer la pose du diagnostic d’ICDA chez les patients souffrant de dyspnée d’origine indéterminée.

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Copyright

Corresponding author

Correspondence to: Dr. Kyle McGivery, Saint John Regional Hospital, Saint John, NB E2L 4L2, Canada; Email: kyle.mcgivery@dal.ca

References

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