ObjectiveFew studies have prospectively evaluated the diagnostic accuracy and temporal impact of ultrasound in the emergency department (ED) in a randomized manner. In this study, we aimed to perform a randomized, standard therapy controlled evaluation of the diagnostic accuracy and temporal impact of a standardized ultrasound strategy, versus standard care, in patients presenting to the ED with acute dyspnea.MethodsThe patients underwent a standardized ultrasound examination that was blinded to the team caring for the patient. Ultrasound results remained blinded in patients randomized to the treating team but were unblinded in the interventional cohort. Scans were performed by trained emergency physicians. The gold standard diagnosis (GSDx) was determined by two physicians blinded to the ultrasound results. The same two physicians reviewed all data >30 days after the index visit.ResultsFifty-nine randomized patients were enrolled. The mean±standard deviation age was 54.4±11 years, and 37 (62%) were male. The most common GSDx was acute heart failure with reduced ejection fraction in 13 (28.3%) patients and airway diseases such as acute exacerbation of asthma or chronic obstructive pulmonary disease in 10 (21.7%). ED diagnostic accuracy, as compared to the GSDx, was 76% in the ultrasound cohort and 79% in the standard care cohort (P=0.796). Compared with the standard care cohort, the final diagnosis was obtained much faster in the ultrasound cohort (mean±standard deviation: 12±3.2 minutes vs. 270 minutes, P<0.001).ConclusionA standardized ultrasound approach is equally accurate, but enables faster ED diagnosis of acute dyspnea than standard care.

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Objectives The aim of this study was to investigate the value of bedside echocardiography with a passive leg raise as a noninvasive marker of volume responsiveness. Methods This work was a prospective observational study of patients with end‐stage renal disease presenting to the emergency department. The left ventricular outflow tract (LVOT) velocity time integral (VTI) was obtained. Measurements before and after dialysis as well as before and after the passive leg raise were recorded. Results Fifty‐four patients were enrolled, in whom the mean volume of fluid removed ± SD was 3.89 ± 0.91 L. In the predialysis cohort, the mean LVOT VTI was 28.05 cm (95% confidence interval [CI], 26.55–29.55 cm). After the passive leg raise, the mean VTI was 28.52 cm (95% CI, 26.98–30.07 cm). In the postdialysis cohort, the mean VTI was 30.31 cm (95% CI, 28.92–31.69 cm), and it increased to 34.91 cm (95% CI, 33.11–36.72 cm) after the passive leg raise. The Δ VTI values were 1.83% (95% CI, 0.12%–3.55%) in the predialysis group and 15.05% (95% CI, 12.76%–17.34%) in the postdialysis cohort. When stratified by fluid removal, the mean Δ VTI values after hemodialysis were 12.64% (95% CI, 9.79%–15.49%) and 16.84% (95% CI, 13.47%–20.22%) for patients who had less than 4 L and 4 L or greater removed, respectively. In patients without congestive heart failure, the Δ VTI was 15.28% (95% CI, 12.25%–18.32%), whereas for those with congestive heart failure, the mean change was 14.63% (95% CI, 10.91%–18.35%). Conclusions The LVOT VTI in conjunction with a passive leg raise seems to correlate with the volume status and volume responsiveness.