Diagnostic accuracy of the multi-organ ultrasound performed by the novice emergency medicine residents for diagnosis of acute heart failure in Thailand

Abstract

© JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2019. Background: Multi-organ ultrasound including inferior vena cava, lung, and cardiac ultrasound improved diagnostic accuracy for diagnosis of acute heart failure (AHF). However, ultrasound from previous studies were performed by experts. Objective: To ascertain the diagnostic accuracy of multi-organ ultrasound performed by the emergency medicine (EM) residents. Materials and Methods: The prospective observational study was conducted in the emergency department of Siriraj Hospital, a large tertiary hospital in Bangkok, Thailand. The patients were enrolled if they were older than 18 years and had acute shortness of breath with AHF as one of differential diagnoses. EM residents who were blinded to the patient’s information performed multi-organ ultrasound in the enrolled patients. The final diagnosis was determined by two emergency physicians by reviewing patient’s medical record and admission summary. Results: Sixty-two patients were enrolled. Of these patients, 40 (64.5%) were diagnosed as AHF. EM residents performed multi-organ ultrasound for diagnosis of AHF with sensitivity of 60%, specificity of 72.7%, positive predictive value (PPV) of 80.0%, and negative predictive value (NPV) of 50%. When correlated clinical data with multi-organ ultrasound, sensitivity was 50%, specificity was 77.3%, PPV was 87.2%, and NPV was 73.9%. Conclusion: Emergency medicine residents can perform multi-organ ultrasound for diagnosis of AHF with moderate diagnostic value.