Background: The value of routine bedside lung ultrasound (LUS) for predicting patient disposition during visits to the Emergency Department (ED) is difficult to quantify. We hypothesized that a simplified scoring of bedside-acquired LUS images for the triage of acute respiratory symptoms in the ED would be associated with patient disposition.
Methods: For this observational pragmatic study, we reviewed prospectively-collected bedside LUS images from patients presenting to the ED with acute respiratory symptoms. We agreed on a simplified LUS scoring approach (0-3). At least three reviewers blindly assessed the available LUS images for each patient and determined the worst score for each patient and the presence of individual LUS findings. The worst LUS score was used to classify patients' LUS-suggested hospital admission risk. We evaluated the agreement between reviewers and the predictive value of LUS findings for patient disposition.
Results: 204 patients were eligible, and 126 sets of images were available and scored. The most common LUS finding were isolated B-lines (63.5 % of LUS images), pleural thickening/irregularity (48.4 %), and diffuse B-lines (43.7 %). The patients' worst LUS score were 2 (43.5 %), 3 (26.1 %), 1 (20.7 %), and 0 (9.8 %). There was good agreement among reviewers on the worst LUS score (intra-class correlation coefficient 0.830, 95 % confidence interval (0.772-0.875)) and the LUS-suggested disposition (ICC 0.882, 95 % CI (0.846, 0.911)).
Conclusion: A simplified scoring of bedside-acquired LUS images from patients with acute respiratory symptoms at the emergency department reliably predicts patient disposition.
Keywords: Emergency medicine; Lung ultrasound; Point of care ultrasound; Triage.
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