Diagnostic Accuracy of a Bespoke Multiorgan Ultrasound Approach in Suspected Pulmonary Embolism

Casper Falster; Gro Egholm; Rune Wiig; Mikael Kjær Poulsen; Jacob Eifer Møller; Stefan Posth; Mikkel Brabrand; Christian Borbjerg Laursen

doi:10.1055/a-1971-7454

Diagnostic Accuracy of a Bespoke Multiorgan Ultrasound Approach in Suspected Pulmonary Embolism

Ultrasound Int Open. 2023 Jan 16;8(2):E59-E67. doi: 10.1055/a-1971-7454. eCollection 2022 Nov.

Authors

Casper Falster^{1

2

3}, Gro Egholm⁴, Rune Wiig², Mikael Kjær Poulsen⁴, Jacob Eifer Møller⁴, Stefan Posth⁵, Mikkel Brabrand⁵, Christian Borbjerg Laursen^{1

2}

Affiliations

¹ Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
² Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
³ OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.
⁴ Department of Cardiology, Odense University Hospital, Odense, Denmark.
⁵ Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.

Abstract

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.

Keywords: echocardiography; embolism/thrombosis; embolization; themes; ultrasound; methods & techniques.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Grants and funding

Funding Information Syddansk Universitet — http://dx.doi.org/10.13039/501100006356; Master Carpenter Jacobsen foundation — Odense Universitetshospital — http://dx.doi.org/10.13039/501100004196;