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Master Thesis

Pertinence diagnostique de l'échographie multimodale dans la prise en charge de la dyspnée aiguë aux urgences

Abstract : Background: Acute dyspnea is a frequent symptom in the emergency department (ED). Emergency physicians must accurately make a diagnosis to guide early and appropriate treatment. The aim of this study is to assess the relevance of a Point of care Ultrasound (PU) in the management of acute dyspnea in the ED. Methods: This prospective, monocentric, observational study was performed in the ED of Timone teaching hospital in Marseille, between October 2017 and April 2018. A multimodal protocol (MP) was performed on patients of 18 years old or more. This protocol included an anamnestic investigation, a complete clinical examination and a PU (lung, heart, and leg vein ultrasonography). The final diagnosis was made after a chest CT, the gold standard. Results: Thirty patients with acute dyspnea were included. Twenty-four patients (24/30, 80%) had the same diagnosis with the MP and chest CT. This result shows a substantial agreement (k= 0.64). A sensitivity of 88.2% (CI 95%: 65.7-96.7) and specificity of 76.9% (CI 95%: 49.7-91.8) were observed for pneumonia, combined cardiac and lung ultrasound, with an area under ROC curve of 0.826. Five patients had a pulmonary embolism diagnosed by both MP and CT angiography. Three of them had a positive ultrasound of the leg veins, while the other two had a cardiac ultrasound in favour of right ventricular dysfunction/ paradoxical septal wall motions toward the left ventricle. Overall, ultrasound of leg veins had a specificity of 100% (CI 95%: 86.7-100) and a sensitivity of 60% (CI 95%: 23.0-88.2), with an area under ROC curve of 0.80. Conclusions: The MP may represent a first diagnostic approach in the ED, accurate and feasible to help differentiate patients who require a second diagnostic test.
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Submitted on : Tuesday, February 26, 2019 - 3:01:20 PM
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Tanina Chouarbi. Pertinence diagnostique de l'échographie multimodale dans la prise en charge de la dyspnée aiguë aux urgences. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02049578⟩



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