Diagnostic Accuracy of Rapid Ultrasound in Shock (RUSH) Exam; A Systematic Review and Meta-analysis

Abstract

Objective:To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED). Methods:We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for meta–analysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included. Results:The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity (0.87, 95% Confidence Interval (CI): 0.80-0.92, I2 = 46.7%) and specificity (0.98, 95% C. I.: 0.96-0.99, I2 = 30.8%). The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98 ± 0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio (19.19, 95% C. I.: 11.49-32.06, I2 = 14.1%) and low negative likelihood ratio (0.23, 95% C. I.: 0.15-0.34, I2 = 18.4%). Conclusion:This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department.

SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock

“…Table 1 summarises the salient ultrasonographic features of the different types of shock. A meta-analysis of the diagnostic accuracy of using the RUSH protocol in the emergency department by Keikha et al (2018) reported a higher sensitivity and specificity in diagnosing hypovolemic, cardiogenic and obstructive shock but lower sensitivity for shock with distributive or mixed aetiology [26]. Despite its limitations, there is growing popularity for the use of POCUS in the intensive care setting.…”

Saved by the pump: Two successful resuscitations utilising emergency department-initiated extracorporeal cardiopulmonary resuscitation in South Africa

“…Bedside ultrasound in the form of the rapid ultrasound for shock and hypotension (RUSH) protocol showed no other abnormalities or cause of cardiac arrest. [13] After a total of 12 defibrillations, cannulation was performed using a femoral approach with the venous (drainage) cannula inserted into the right groin and the arterial (return) cannula into the left groin, and ECLS was instituted using the Novalung iLA device (Novalung GmbH, Germany).…”

Novas tecnologias e excelência na unidade de emergência

“…However, the current technological resource that had the most significant impact in improving diagnostic accuracy at the bedside was portable ultrasound (connected to a cell phone or tablet) as an extension of the physical examination. A broad and progressive scientific evidence, mainly in patients with acutely manifested dyspnea and undifferentiated shock, shows that the positive and negative likelihood ratio of the lung, heart, and large veins for diagnosis of various etiologies, is greater than the clinical, electrocardiographic evaluation, radiographic and with biomarkers 12,13 . A good emergency room has an ultrasound device; in a Unit of excellence, ultrasonography is an integral part of clinical evaluation.…”