Novice Point-of-Care Ultrasound for the Diagnosis 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.