Résumé
Objectives: Lung ultrasound has value in diagnosing dyspnea. The main objective of this study was to evaluate the accuracy of a modified lung ultrasound (MLUS) score to predict the severity of acute dyspnea in elderly patients.
Methods: This was an observational single-centre study including patients over age 64 admitted to the emergency department for acute dyspnea with hypoxia. Participants had an early lung ultrasound performed by a dedicated emergency physician, followed by the usual care by a team blinded to the lung ultrasound results. Patients were allocated by disposition to either a critical care (CC) group (patients who needed admission to the intensive care unit [ICU] and/or who died within 48 h) or a standard care group.
Results: Among 137 patients analysed (mean age 79 +/- 13 years, 74 [54%] women), 43 (31%) were categorized into the CC group. The time taken to obtain the MLUS was 30 +/- 22 min. The area under the receiver operating characteristic curve of the MLUS for predicting the CC group was 0.97 (0.92-0.99; p<0.01) with a cut-off set strictly above 17 for 93% sensitivity (81-99), 99% specificity (94-100), a positive predictive value of 98% (87-100), a negative predictive value of 97% (91-99), a positive likelihood ratio of 86, a negative likelihood ratio of 0.07, and a diagnostic accuracy of 97% (93-99). In a multivariate analysis, the MLUS was the only independent associated factor for the CC group.
Conclusion: An early lung ultrasound score can predict the need for ICU admission and/or death within 48 hours in elderly dyspneic patients.