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Am J Emerg Med. 2019 Feb 20. pii: S0735-6757(19)30112-3. doi: 10.1016/j.ajem.2019.02.028. [Epub ahead of print]

BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea.

Author information

1
Etimesgut State Hospital, Emergency Service, Ankara, Turkey.
2
Gazi University School of Medicine, Department of Emergency Medicine, Ankara, Turkey. Electronic address: isakilicaslan@gazi.edu.tr.
3
Gazi University School of Medicine, Department of Emergency Medicine, Ankara, Turkey.
4
Izmir Health Science University, Tepecik Training and Research Hospital, Emergency Medicine Clinic, Izmir, Turkey.
5
Kastamonu State Hospital, Emergency Service, Kastamonu, Turkey.
6
Sanlıurfa Health Science University, Mehmet Akif Inan Training and Research Hospital, Emergency Service, Sanliurfa, Turkey.

Abstract

OBJECTIVE:

Dyspnea is a common Emergency Department (ED) symptom requiring prompt diagnosis and treatment. The bedside lung ultrasonography in emergency (BLUE) protocol is defined as a bedside diagnostic tool in intensive care units. The aim of this study was to investigate the test performance characteristics of the BLUE-protocol ultrasonography in ED patients presenting with acute dyspnea.

METHOD:

This study was performed as a prospective observational study at the ED of a tertiary care university hospital over a 3-month period. The BLUE-protocol was applied to all consecutive dyspneic patients admitted to the ED by 5 emergency physicians who were certified for advanced ultrasonography. In addition to the BLUE-protocol, the patients were also evaluated for pleural and pericardial effusion.

RESULTS:

A total of 383 patients were included in this study (mean age, 65.5 ± 15.5 years, 183 (47.8%) female and 200 (52.2%) male). According to the BLUE-protocol algorithm, the sensitivities and specificities of the BLUE-protocol are, respectively, 87.6% and 96.2% for pulmonary edema, 85.7% and 99.0% for pneumonia, 98.2% and 67.3% for asthma/COPD, 46.2% and 100% for pulmonary embolism, and 71.4% and 100% for pneumothorax. Although not included in the BLUE-protocol algorithm, pleural or pericardial effusion was detected in 82 (21.4%) of the patients.

CONCLUSION:

The BLUE-protocol can be used confidently in acute dyspneic ED patients. For better diagnostic utility of the BLUE-protocol in EDs, it is recommended that the BLUE-protocol be modified for the assessment of pleural and pericardial effusion. Further diagnostic evaluations are needed in asthma/COPD groups in terms of the BLUE-protocol.

KEYWORDS:

BLUE protocol; Bedside lung ultrasonography; Dyspnea; Emergency Department

PMID:
30819579
DOI:
10.1016/j.ajem.2019.02.028

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