Ultrasound on the Frontlines: Empowering Paramedics with Lung Ultrasound for Dyspnea Diagnosis in Adults-A Pilot Study

Damian Kowalczyk; Miłosz Turkowiak; Wojciech Jerzy Piotrowski; Oskar Rosiak; Adam Jerzy Białas

doi:10.3390/diagnostics13223412

Ultrasound on the Frontlines: Empowering Paramedics with Lung Ultrasound for Dyspnea Diagnosis in Adults-A Pilot Study

Diagnostics (Basel). 2023 Nov 9;13(22):3412. doi: 10.3390/diagnostics13223412.

Authors

Damian Kowalczyk¹, Miłosz Turkowiak², Wojciech Jerzy Piotrowski¹, Oskar Rosiak³, Adam Jerzy Białas^{1

4}

Affiliations

¹ Department of Pneumology, 2nd Chair of Internal Medicine, Medical University of Lodz, 90-419 Lodz, Poland.
² Department of Anesthesiology and Intensive Care, National Institute of Medicine of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland.
³ Department of Otolaryngology, Polish Mother's Memorial Hospital Research Institute, 93-338 Lodz, Poland.
⁴ Department of Pulmonary Rehabilitation, Regional Medical Center for Lung Diseases and Rehabilitation, Blessed Rafal Chylinski Memorial Hospital for Lung Diseases, 91-520 Lodz, Poland.

Abstract

Lung transthoracic ultrasound (LUS) is an accessible and widely applicable method of rapidly imaging certain pathologies in the thorax. LUS proves to be an optimal tool in respiratory emergency medicine, applicable in various clinical settings. However, despite the rapid development of bedside ultrasonography, or point-of-care (POCUS) ultrasound, there remains a scarcity of knowledge about the use of LUS in pre-hospital settings. Therefore, our aim was to assess the usefulness of LUS as an additional tool in diagnosing dyspnea when performed by experienced paramedics in real-life, pre-hospital settings. Participants were recruited consecutively among patients who called for an emergency due to dyspnea in the Warsaw region of Poland. All the enrolled patients were admitted to the Emergency Department (ED). In the prehospital setting, a paramedic experienced in LUS conducted an ultrasonographic examination of the thorax, including Bedside Lung Ultrasound in Emergency (BLUE) and extended Focused Assessment with Sonography for Trauma (eFAST) protocols. The paramedic's diagnosis was compared to the ED diagnosis, and if available, to the final diagnosis established on the day of discharge from the hospital. We enrolled 44 patients in the study, comprising 22 (50%) men and (50%) women with a median age of 76 (IQR: 69.75-84.5) years. The LUS performed by paramedic was concordant with the discharge diagnosis in 90.91% of cases, where the final diagnosis was established on the day of discharge from the hospital. In cases where the patient was treated only in the ED, the pre-hospital LUS was concordant with the ED diagnosis in 88.64% of cases. The mean time of the LUS examination was 63.66 s (SD: 19.22). The inter-rater agreement between the pre-hospital diagnosis and ER diagnosis based on pre-hospital LUS and complete ER evaluation was estimated at k = 0.822 (SE: 0.07; 95%CI: 0.68, 0.96), indicating strong agreement, and between the pre-hospital diagnosis based on LUS and final discharge diagnosis, it was estimated at k = 0.934 (SE: 0.03; 95%CI: 0.88, 0.99), indicating almost perfect agreement. In conclusion, paramedic-acquired LUS seems to be a useful tool in the pre-hospital differential diagnosis of dyspnea in adults.

Keywords: BLUE; POCUS; dyspnea; eFAST; point-of-care ultrasound; thoracic ultrasound.

Grants and funding

This study was funded by the Medical University of Lodz. Study-related costs were defrayed from the research resources of the Department of Pathobiology of Respiratory Diseases (currently part of the Department of Pneumology) and the Department of Pneumology. The APC was funded by the Department of Pneumology and the Medical University of Lodz.