Article Text
Abstract
Introduction Thoracic ultrasound (TUS) has become indispensable when assessing the acutely unwell respiratory patient. We examined the impact of TUS on clinical decision-making and patient management, inviting discussion regarding the routine use of TUS on the respiratory post-take ward round (PTWR).
Methods Data was collected prospectively from fifty consecutive patients allocated to the acute respiratory PTWR. TUS was performed and standardised utilising the validated ‘BLUE protocol’, performed by the same operator. Domains included demographics, respiratory comorbidities, diagnoses, and management plans prior to, and following TUS.
Results Of fifty patients scanned, TUS altered overall management in 22 (44%). Primary diagnosis was changed in 26%, treatments in 34%, investigations in 28%, and all three aspects in 18%. TUS performed well in fluid balance decisions and identifying lung consolidation.
Patient groups where TUS would not alter management were identified, with reduced odds seen with pre-existing airways disease (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.12–1.17), and in patients with airways disease and wheeze on auscultation (OR 0.08, 95%, CI 0.01–0.77).
Chest x-ray (CXR) reports differed from TUS findings in 12 (24%). 21 (42%) patients later underwent computed tomography (CT) examination with CT reports corresponding with positive TUS findings in 100%, with no further emendation of diagnoses (excluding incidental findings). Data was not collected to assess the time implications of performing ultrasound on the consultation, and we acknowledge that not all Respiratory physicians are ultrasound trained thus limiting the provision of thoracic ultrasound.
Discussion The use of TUS impacted significantly on decision-making on the Respiratory PTWR. Unnecessary radiology requests, ionising radiation, and cost were avoided. Within the constraints of the study group, TUS seems less useful when assessing patients with pre-existing airways disease. TUS has excellent correlation with CT findings, outperforms CXR, appearing to offer a comprehensive, streamlined respiratory assessment at the ‘front-door’.
With ultrasound becoming more accessible to clinicians, and with increasing demands on CT departments, we welcome discussion regarding regular use of TUS on the PTWR. Further data would be desirable to assess whether its use early in admission is correlated with a reduced length of stay and improved patient outcomes.