Effect of chest ultrasound on diagnostic workup in elderly patients with acute respiratory failure in the emergency department: a prospective study

Diagnostic assessment of acute respiratory failure in elderly patients is often challenging, and initial misdiagnosis is associated with poorer outcomes. Chest ultrasound could help to improve diagnostic performance in this population. The objective of our study was to assess chest ultrasound (i.e. combined cardiac and lung ultrasound) add-on investigation to standard diagnosis approach in elderly patients presenting to the emergency department (ED) with acute respiratory failure. Methods We carried out a prospective study performed in our ED, included patients older than 75 years presenting with acute respiratory failure. Noninclusion criteria were documented palliative care or the need for immediate intensive care. After informed consent approval and routine diagnostic procedure (clinical, radiological and laboratory tests), the ED physician established the first diagnosis. Chest ultrasound was then performed, and a second diagnosis was established. An adjudication committee also established a diagnosis. The unweighted Cohen's kappa (kappa) coefficient was used to measure the strength of agreement between routine diagnostic approach, chest ultrasound and adjudication committee diagnosis. Results A total of 89 patients were included, mean age 86 +/- 5 years old. Concordance was very good (kappa = 0.82) between chest ultrasound and adjudication committee diagnostic and moderate (kappa = 0.52) between routine diagnostic approach and adjudication committee diagnostic. Cardiogenic pulmonary edema and community-acquired pneumonia were the most frequent diagnoses (48.5 and 27%, respectively). Chest ultrasound had higher sensitivity and specificity for both diagnoses. Conclusion In our study, chest ultrasound add-on investigation to standard approach improved diagnosis performance in elderly patients presenting to the ED with acute respiratory failure. Further multicenter randomized trials are warranted to confirm this finding.