Diagnostic Accuracy of a Bespoke Multiorgan Ultrasound Approach in
                    Suspected Pulmonary Embolism

Casper Falster; Gro Egholm; Rune Wiig; Mikael Kjær Poulsen; Jacob Eifer Møller; Stefan Posth; Mikkel Brabrand; Christian Borbjerg Laursen

doi:10.1055/a-1971-7454

Ultrasound International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Ultrasound Int Open 2022; 08(02): E59-E67
DOI: 10.1055/a-1971-7454

Original Article

Diagnostic Accuracy of a Bespoke Multiorgan Ultrasound Approach in Suspected Pulmonary Embolism

Authors

Casper Falster

¹Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark

²Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark

³OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
Gro Egholm

⁴Department of Cardiology, Odense University Hospital, Odense, Denmark
Rune Wiig

²Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Mikael Kjær Poulsen

⁴Department of Cardiology, Odense University Hospital, Odense, Denmark
Jacob Eifer Møller

⁴Department of Cardiology, Odense University Hospital, Odense, Denmark
Stefan Posth

⁵Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
Mikkel Brabrand

⁵Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
Christian Borbjerg Laursen

¹Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark

²Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark

Abstract

Purpose The aims of this study were to prospectively assess the diagnostic accuracy of a bespoke multiorgan point-of-care ultrasound approach for suspected pulmonary embolism and evaluate if this model allows reduced referral to further radiation diagnostics while maintaining safety standards.

Materials and Methods Patients with suspected pulmonary embolism referred for CT pulmonary angiography or ventilation/perfusion scintigraphy were included as a convenience sample. All patients were subject to blinded ultrasound investigation with cardiac, lung, and deep venous ultrasound. The sensitivity and specificity of applied ultrasound signs and the hypothetical reduction in the need for further diagnostic workup were calculated.

Results 75 patients were prospectively enrolled. The Wells score was below 2 in 48 patients, between 2 and 6 in 24 patients, and above 6 in 3 patients. The prevalence of pulmonary embolism was 28%. The most notable ultrasound signs were presence of a deep venous thrombus, at least two hypoechoic pleural-based lesions, the D-sign, the 60/60-sign, and a visible right ventricular thrombus which all had a specificity of 100%. Additionally, a multiorgan ultrasound investigation with no findings compatible with pulmonary embolism yielded a sensitivity of 95.2% (95%CI: 76.2–99.9). CT or scintigraphy could be safely avoided in 70% of cases (95%CI: 63.0–83.1%).

Conclusion The findings of our study suggest that implementation of a multiorgan ultrasound assessment in patients with suspected pulmonary embolism may safely reduce the need for CT or scintigraphy by confirming or dismissing the suspicion.

Key words

ultrasound - methods & techniques - echocardiography - embolization - embolism/thrombosis - themes

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Referenzen

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