The diagnostic capabilities of the combined cardiac and lung point of care ultrasound in shocked patients at the emergency department - Resourced limited country

Kamonwon Ienghong; Lap Woon Cheung; Somsak Tiamkao; Vajarabhongsa Bhudhisawasdi; Korakot Apiratwarakul

doi:10.1016/j.ejro.2022.100446

The diagnostic capabilities of the combined cardiac and lung point of care ultrasound in shocked patients at the emergency department - Resourced limited country

Eur J Radiol Open. 2022 Oct 8:9:100446. doi: 10.1016/j.ejro.2022.100446. eCollection 2022.

Authors

Kamonwon Ienghong^{1

2}, Lap Woon Cheung^{3

4}, Somsak Tiamkao⁵, Vajarabhongsa Bhudhisawasdi¹, Korakot Apiratwarakul^{1

2}

Affiliations

¹ Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
² Development of integrated Point of Care Ultrasound Used in Emergency Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
³ Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong.
⁴ Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
⁵ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Abstract

Purpose: Cardiac, lung, and inferior vena cava (IVC) ultrasound are commonly performed in the care of emergency patients especially patient presented with hypotension or shock. However, the literature indicated the limitation of IVC to assess shocked patients. This study aims to determine the efficacy of combined cardiac and lung ultrasound for evaluation the etiology of shock.

Materials and methods: A cross-sectional study was conducted on patient with shock at emergency department, Srinagarind Hospital, Thailand, from January to December 2021. Adult shocked patients who met the criteria were included in this study. Ultrasound and emergency department medical records were documented and analyzed as sensitivity, specificity, predictive value, negative predictive value, diagnostic accuracy, and Cohen's kappa coefficient (κ).

Results: One hundred and two who met the criteria were enrolled. Combined cardiac and lung scans were found to be accurate 99.02% and 93.04% in obstructive and cardiogenic shock. In patients with obstructive shock was the almost perfect agreement, (κ) = 0.85. However, distributive, and hypovolemic shock had the low concordance with the final hospital diagnosis, (κ) = 0.37 and 0.43, respectively.

Conclusions: The integration of cardiac and lung ultrasound can be effectively used to narrow differential diagnosis of shock.

Keywords: Circulatory failure; Echocardiography; Emergencies; Lung; Shock; Ultrasonography.