Comprehensive Physical Exam versus Lung Ultrasound for Dyspneic Patients in the Emergency Department

ObjectiveOverreliance on technology has led to dwindling physical exam (PE) skills. We compared the diagnostic accuracy of a structured lung physical examination (L-PE) to structured lung ultrasound (LUS) in ED patients with undifferentiated dyspnea. We also examined the change in differential diagnosis and degree of certainty based on order and type of exam MethodsThis was a prospective, randomized, crossover study of a convenience sample of adult ED patients with undifferentiated dyspnea. Comprehensive L-PE and LUS were performed in random order followed by the other exam. An adjudication committee determined the final diagnosis based on all available data and served as the criterion standard. Primary outcome was diagnostic accuracy. A sample of 86 patients had 80% power to detect a 25% difference in diagnostic accuracy. ResultsA total of 102 patients were enrolled. Similar accuracies were found between L-PE and LUS for both COPD [75% (95% CI 65-83) vs. 76% (95% CI 67-84)] and asthma [87% (95% CI 79-93) vs. 87% (95 CI 79-93)]. LUS [81% (95 CI 72-88)] was slightly more accurate compared to L-PE [72% (95 CI 62-80)] for diagnosis of pneumonia but not statistically significant. For patients presenting with pulmonary edema, LUS was slightly [76% (95 CI 66-84)] more accurate than L-PE [73% (95 CI 63-81)], but not statistically significant. Finally, for detecting pleural effusions, L-PE [96% (95 CI 90-99)] was more accurate than LUS [82% (95 CI 73-89)]. ConclusionsThe diagnostic accuracies of comprehensive lung physical examination and focused lung ultrasound were generally similar in ED patients with dyspnea and should be used concurrently to maximize diagnostic accuracy.