Multicentre randomised controlled trial incorporating bedside lung ultrasound into the diagnosis of congestive cardiac failure in breathless older patients.

Improving diagnosis of cardiac failure in breathless older patients using lung ultrasound

Grant ID: EMPJ103R19 2013

Project Summary

Many older persons present to the Emergency Department complaining of shortness of breath (Dyspnoea). This can be an important forewarning of heart failure, but is also present in many other conditions. In most cases, several bedside tests are carried out to identify those patients with heart failure. Despite these investigations, which include blood tests, electrocardiograph and chest x-ray, heart failure is initially misdiagnosed in up to one quarter of patients in the emergency department. This project focuses on secondary prevention of the complications of the disease caused by missed diagnosis.

Some European hospitals use bedside lung ultrasound as an adjunct to the above tests, claiming it improves recognition of heart failure, and should decrease the time to appropriate treatment. The European model of ultrasound practice is significantly different from the Australian model, and there is limited evidence supporting either model provided in the literature.

This is a multi-centre study following on from a successful pilot project. A safe, simple protocol has been tested in an Australian Emergency Department, in parallel to normal diagnostic strategies. To prove the protocol actually improves patient care, it now has to be tested as part of the diagnostic workup for breathlessness compared with the conventional diagnostic procedure.

Dissemination

Baker, K., Brierley, S., Kinnear, F., Isoardi, K., Livesay, G., Stieler, G. and Mitchell, G., 2020. Implementation study reporting diagnostic accuracy, outcomes and costs in a multicentre randomised controlled trial of non‐expert lung ultrasound to detect pulmonary oedema. Emergency Medicine Australasia, 32(1), pp.45-53.

Zoneff, E.R., Baker, K., Sweeny, A., Keijzers, G., Sanderson, J. and Watkins, S., 2019. The prevalence of lung surface abnormalities in a healthy population as detected by a screening lung ultrasound protocol: Comparison between young and older volunteers. Australasian Journal of Ultrasound in Medicine, 22(2), pp.129-137.

Shrestha, G.S., Weeratunga, D. and Baker, K., 2018. Point-of-care lung ultrasound in critically ill patients. Reviews on recent clinical trials, 13(1), pp.15-26.

Baker, K., Mitchell, G., Thompson, A.G., Stieler, G. and Rippey, J., 2015. Lung ultrasound in heart failure: Lessons from re‐analysis of Lung Ultrasound 2011 database. Australasian journal of ultrasound in medicine, 18(1), pp.10-18.

Conference Presentations/Abstracts:
- EMF Research Symposium, Brisbane, 24 August 2017
- Australasian College for Emergency Medicine, Annual Scientific Meeting, Sydney, 23 November 2017.
-Australasian Society for Ultrasound in Medicine, Annual Scientific Meeting, Point of Care stream, Sydney, 10-11th September 2016 . Invited speaker and clinical lead (45 minute oral presentation followed by 1.5 hour practical workshop on 10th).
-Australasian College for Emergency Medicine, Annual Scientific Meeting, Brisbane 25th November 2016, invited speaker (30 minute oral presentation)

Invited Expert:
- Ultrafest, Perth, 14-18 August 2017
- Emergency Medicine Ultrasound Group (Sydney) meeting on 10th September 2016
- Invited facilitator of Point of Care Workshop (Cooma, August 1st 2016)
- Invited speaker/tutor/lung expert for Ultrafest (Perth, August 17-22nd 2016)

Video/Presentations

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