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ED Lung Ultrasound Useful for Differentiating Cardiogenic from Noncardiogenic Dyspnea
Author(s)
Steven Deitelzweig, MD, SFHM
William Carter, MD
David Kitchell, MD
Alan Hathcock, MD
Jeremiah Newsom, MD
Frank Wharton, MD

Clinical question: Is lung ultrasound a useful tool for helping to diagnose acute decompensated heart failure (ADHF)?

Background: Lung ultrasound is an emerging bedside tool that has been promoted to help evaluate lung water content to help clinicians differentiate ADHF from other causes of dyspnea.

Study design: Prospective, multicenter, observational cohort study.

Setting: Seven EDs in Italy.

Synopsis: A total of 1,005 patients were enrolled in the study. Upon presentation to the ED, patients received a standard workup, including history, physical examination, EKG, and arterial blood gas sampling. Physicians were asked to render a diagnosis of ADHF or noncardiogenic dyspnea. The same physician then performed a lung ultrasound and rendered a revised diagnosis based on the ultrasound findings. A second ED physician and cardiologist, blinded to the ultrasound results, reviewed the medical record and rendered a final diagnosis as to the cause of the patient’s dyspnea.

The ultrasound approach had a higher accuracy than clinical evaluation alone in differentiating ADHF from noncardiac causes of dyspnea (97% vs. 85.3%). The authors also report a higher sensitivity compared to chest X-ray alone (69.5%) and natriuretic peptide testing (85%).

Bottom line: Lung ultrasound combined with clinical evaluation may improve the accuracy of ADHF diagnosis, but its usefulness may be limited by the need for ED physicians to have some degree of expertise in the use of ultrasound.

Citation: Pivetta E, Goffi A, Lupia E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest. 2015;148(1):202-210.

Short Takes

Medicare planning to reimburse for end-of-life discussions

A proposed change to the Medicare Physician Fee Schedule for 2016 involves the creation of CPT codes and payments to cover advanced care planning services so discussions can occur at appropriate times.

Citation: Centers for Medicare and Medicaid Services. Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016. July 8, 2015. Accessed Sept. 15, 2015.

Educational interventions on resuscitation training increase the likelihood of survival after out-of-hospital cardiac arrest

Training community members and first responders in CPR and AEDs increased the likelihood of patients surviving out-of-hospital cardiac arrest with a favorable neurologic outcome from 7.1% to 9.7%.

Citation: Malta Hansen CM, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA. 2015;314(3):255-264.

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The Hospitalist - 2015(11)
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Author(s)
Steven Deitelzweig, MD, SFHM
William Carter, MD
David Kitchell, MD
Alan Hathcock, MD
Jeremiah Newsom, MD
Frank Wharton, MD
Author(s)
Steven Deitelzweig, MD, SFHM
William Carter, MD
David Kitchell, MD
Alan Hathcock, MD
Jeremiah Newsom, MD
Frank Wharton, MD

Clinical question: Is lung ultrasound a useful tool for helping to diagnose acute decompensated heart failure (ADHF)?

Background: Lung ultrasound is an emerging bedside tool that has been promoted to help evaluate lung water content to help clinicians differentiate ADHF from other causes of dyspnea.

Study design: Prospective, multicenter, observational cohort study.

Setting: Seven EDs in Italy.

Synopsis: A total of 1,005 patients were enrolled in the study. Upon presentation to the ED, patients received a standard workup, including history, physical examination, EKG, and arterial blood gas sampling. Physicians were asked to render a diagnosis of ADHF or noncardiogenic dyspnea. The same physician then performed a lung ultrasound and rendered a revised diagnosis based on the ultrasound findings. A second ED physician and cardiologist, blinded to the ultrasound results, reviewed the medical record and rendered a final diagnosis as to the cause of the patient’s dyspnea.

The ultrasound approach had a higher accuracy than clinical evaluation alone in differentiating ADHF from noncardiac causes of dyspnea (97% vs. 85.3%). The authors also report a higher sensitivity compared to chest X-ray alone (69.5%) and natriuretic peptide testing (85%).

Bottom line: Lung ultrasound combined with clinical evaluation may improve the accuracy of ADHF diagnosis, but its usefulness may be limited by the need for ED physicians to have some degree of expertise in the use of ultrasound.

Citation: Pivetta E, Goffi A, Lupia E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest. 2015;148(1):202-210.

Short Takes

Medicare planning to reimburse for end-of-life discussions

A proposed change to the Medicare Physician Fee Schedule for 2016 involves the creation of CPT codes and payments to cover advanced care planning services so discussions can occur at appropriate times.

Citation: Centers for Medicare and Medicaid Services. Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016. July 8, 2015. Accessed Sept. 15, 2015.

Educational interventions on resuscitation training increase the likelihood of survival after out-of-hospital cardiac arrest

Training community members and first responders in CPR and AEDs increased the likelihood of patients surviving out-of-hospital cardiac arrest with a favorable neurologic outcome from 7.1% to 9.7%.

Citation: Malta Hansen CM, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA. 2015;314(3):255-264.

Clinical question: Is lung ultrasound a useful tool for helping to diagnose acute decompensated heart failure (ADHF)?

Background: Lung ultrasound is an emerging bedside tool that has been promoted to help evaluate lung water content to help clinicians differentiate ADHF from other causes of dyspnea.

Study design: Prospective, multicenter, observational cohort study.

Setting: Seven EDs in Italy.

Synopsis: A total of 1,005 patients were enrolled in the study. Upon presentation to the ED, patients received a standard workup, including history, physical examination, EKG, and arterial blood gas sampling. Physicians were asked to render a diagnosis of ADHF or noncardiogenic dyspnea. The same physician then performed a lung ultrasound and rendered a revised diagnosis based on the ultrasound findings. A second ED physician and cardiologist, blinded to the ultrasound results, reviewed the medical record and rendered a final diagnosis as to the cause of the patient’s dyspnea.

The ultrasound approach had a higher accuracy than clinical evaluation alone in differentiating ADHF from noncardiac causes of dyspnea (97% vs. 85.3%). The authors also report a higher sensitivity compared to chest X-ray alone (69.5%) and natriuretic peptide testing (85%).

Bottom line: Lung ultrasound combined with clinical evaluation may improve the accuracy of ADHF diagnosis, but its usefulness may be limited by the need for ED physicians to have some degree of expertise in the use of ultrasound.

Citation: Pivetta E, Goffi A, Lupia E, et al. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study. Chest. 2015;148(1):202-210.

Short Takes

Medicare planning to reimburse for end-of-life discussions

A proposed change to the Medicare Physician Fee Schedule for 2016 involves the creation of CPT codes and payments to cover advanced care planning services so discussions can occur at appropriate times.

Citation: Centers for Medicare and Medicaid Services. Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year 2016. July 8, 2015. Accessed Sept. 15, 2015.

Educational interventions on resuscitation training increase the likelihood of survival after out-of-hospital cardiac arrest

Training community members and first responders in CPR and AEDs increased the likelihood of patients surviving out-of-hospital cardiac arrest with a favorable neurologic outcome from 7.1% to 9.7%.

Citation: Malta Hansen CM, Kragholm K, Pearson DA, et al. Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010-2013. JAMA. 2015;314(3):255-264.

Issue
The Hospitalist - 2015(11)
Issue
The Hospitalist - 2015(11)
Publications
The Hospitalist
B-Cell Lymphoma ICYMI
Breast Cancer ICYMI
Publications
The Hospitalist
B-Cell Lymphoma ICYMI
Breast Cancer ICYMI
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ED Lung Ultrasound Useful for Differentiating Cardiogenic from Noncardiogenic Dyspnea
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ED Lung Ultrasound Useful for Differentiating Cardiogenic from Noncardiogenic Dyspnea
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