BLUE protocol ultrasonography in Emergency Department patients presenting with acute dyspnea

• Published in: The American journal of emergency medicine 2019-11, Vol.37 (11), p.2020-2027
• Main Authors: Bekgoz, Burak, Kilicaslan, Isa, Bildik, Fikret, Keles, Ayfer, Demircan, Ahmet, Hakoglu, Onur, Coskun, Gulhan, Demir, Huseyin Avni
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Algorithms; Asthma; Bedside lung ultrasonography; BLUE protocol; Cardiovascular disease; Chronic obstructive pulmonary disease; Clinical Protocols; Cross-Sectional Studies; Diagnostic software; Dyspnea; Dyspnea - diagnostic imaging; Dyspnea - etiology; Edema; Effusion; Embolism; Embolisms; Emergency Department; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Family medical history; Female; Heart failure; Hospitals; Humans; Intensive care; Intensive care units; Laboratories; Lung - diagnostic imaging; Lung Diseases - complications; Lung Diseases - diagnostic imaging; Male; Middle Aged; Observational studies; Patients; Physicians; Pneumonia; Pneumothorax; Point-of-Care Testing; Prospective Studies; Respiration; Sensitivity and Specificity; Thromboembolism; Thrombosis; Ultrasonic imaging; Ultrasonography; Ultrasound; X-rays
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.02.028

Dyspnea is a common Emergency Department (ED) symptom requiring prompt diagnosis and treatment. The bedside lung ultrasonography in emergency (BLUE) protocol is defined as a bedside diagnostic tool in intensive care units. The aim of this study was to investigate the test performance characteristics of the BLUE-protocol ultrasonography in ED patients presenting with acute dyspnea. This study was performed as a prospective observational study at the ED of a tertiary care university hospital over a 3-month period. The BLUE-protocol was applied to all consecutive dyspneic patients admitted to the ED by 5 emergency physicians who were certified for advanced ultrasonography. In addition to the BLUE-protocol, the patients were also evaluated for pleural and pericardial effusion. A total of 383 patients were included in this study (mean age, 65.5 ± 15.5 years, 183 (47.8%) female and 200 (52.2%) male). According to the BLUE-protocol algorithm, the sensitivities and specificities of the BLUE-protocol are, respectively, 87.6% and 96.2% for pulmonary edema, 85.7% and 99.0% for pneumonia, 98.2% and 67.3% for asthma/COPD, 46.2% and 100% for pulmonary embolism, and 71.4% and 100% for pneumothorax. Although not included in the BLUE-protocol algorithm, pleural or pericardial effusion was detected in 82 (21.4%) of the patients. The BLUE-protocol can be used confidently in acute dyspneic ED patients. For better diagnostic utility of the BLUE-protocol in EDs, it is recommended that the BLUE-protocol be modified for the assessment of pleural and pericardial effusion. Further diagnostic evaluations are needed in asthma/COPD groups in terms of the BLUE-protocol.