Impact of bedside lung ultrasound on physician clinical decision-making in the emergency department: A prospective cross-sectional study.

Veena  Bharat; Raj Bahadur   Singh; Santosh Kumar  Nayan

doi:10.51168/sjhrafrica.v7i3.2516

Authors

Dr. Veena Bharati Senior resident, Department of Emergency Medicine, IGIMS, Patna, Bihar, India.
Raj Bahadur Singh Assistant Professor, Department of Trauma and Emergency, IGIMS, Patna, Bihar, India.
Santosh Kumar Nayan Assistant Professor, Department of Trauma and Emergency, IGIMS, Patna, Bihar, India.

DOI:

https://doi.org/10.51168/sjhrafrica.v7i3.2516

Keywords:

Bedside lung ultrasound, emergency department, clinical decision-making, respiratory distress, point-of-care ultrasound

Abstract

Background

Rapid and accurate diagnosis of respiratory conditions in the emergency department (ED) is crucial for timely management. Bedside lung ultrasonography (LUS) has emerged as a valuable point-of-care tool for evaluating patients with acute respiratory symptoms.

Objective

To assess the impact of bedside lung ultrasonography on physicians’ clinical decision-making in patients presenting with acute respiratory distress in the emergency department.

Methods

This prospective cross-sectional study was conducted over 18 months in the emergency department of a tertiary care hospital. A total of 50 adult patients presenting with acute respiratory symptoms were included. Physicians initially documented provisional diagnoses and management plans based on clinical evaluation and standard investigations. Following LUS examination, diagnoses and management plans were reassessed. Changes were analyzed using the chi-square test, with p < 0.05 considered statistically significant.

Results

Bedside lung ultrasonography resulted in a change in diagnosis in 34.2% of cases and altered clinical management in 41.7% of patients. Significant improvements were observed in diagnosing pneumonia, pulmonary edema, and pneumothorax (p < 0.05).

Conclusion

Bedside LUS significantly enhances diagnostic accuracy and influences management decisions in emergency settings. Its routine use can improve patient outcomes and optimize resource utilization.

Recommendation

Integration of lung ultrasonography into routine emergency practice is recommended, along with adequate physician training. Further multicenter studies with larger sample sizes are needed to validate these findings.

References

Leopoldo F, Neto D, Mara J, Andrade S De, Carolina A, Raupp T, et al. Diagnostic accuracy of the Bedside Lung Ultrasound in Emergency protocol for the diagnosis of acute respiratory failure in spontaneously breathing patients. J Bras Pneumol. 2015;41(1):58-64. https://doi.org/10.1590/S1806-37132015000100008

Biswas A. The role of bedside point-of-care ultrasound evaluation of the lung in the critically ill patient. J Emerg Crit Care Med. 2017;1(34):1-7. https://doi.org/10.21037/jeccm.2017.10.09

Heldeweg MLA, Vermue L, Kant M, Brouwer M, Girbes ARJ, Haaksma ME, et al. The impact of lung ultrasound on clinical decision making across departments: a systematic review. Ultrasound J [Internet]. 2022;14(5):1-8. Available from: https://doi.org/10.1186/s13089-021-00253-3

Up M, Pa D, Rr D, Gs P, Hr D. Utility of Bedside Lung Ultrasound in Emergency (Blue) Protocol as a Diagnostic Tool in Patients with Acute Respiratory Distress Presenting in the Emergency Department. Int J Pharm Clin Res. 2024;16(8):1488-94.

Papanagnou D, Secko M, Gullett J, Stone M. Clinician-Performed Bedside Ultrasound in Improving Diagnostic Accuracy in Patients Presenting to the ED with Acute Dyspnea. Let us know how access to this document benefits you. Clinician-Performed Bedside Ultrasound in Improving Diagnostic Accuracy in P. West J Emerg Med. 2017;18(3):382-9. https://doi.org/10.5811/westjem.2017.1.31223

Rocca E, Zanza C, Longhitano Y, Piccolella F, Romenskaya T, Racca F, et al. Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review. Adv Respir Med. 2023;91:203-23. https://doi.org/10.3390/arm91030017

House DR, Amatya Y, Nti B, Russell FM. Impact of bedside lung ultrasound on physician clinical decision-making in an emergency department in Nepal. nternational J Emerg Med. 2020;13(14):1-5. https://doi.org/10.1186/s12245-020-00273-1