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.