Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs

Methodology: 2.5/5          
Usefulness: 3/5

Daley JI, et al. Acad Emerg Med 26 (11), 1211-1220 Nov 2019

Questions and methods: In patients with abnormal vital signs, what is the sensitivity of FOCUS for the diagnosis of PE? Prospective, multicenter, observational study.

Findings: 136 patients with pending CTPE, subdivided in (1) HR≥100 BPM and/or sBP <90 mmHg, or (2) HR≥110 BPM. For the former, FOCUS was 92% sensitive and 64% specific, (-)LR of 0.13, while in the latter sensitivity was 100% and specificity of 63%.

Limitations: Convenience sample, highly selected group of patients at high risk for PE, partial unblinding, large difference in skills of sonographers (medical students vs PoCUS-fellowship trained physicians).

Interpretation: FOCUS does not have high enough diagnostic accuracy to safely rule in or out PE; a negative exam may lower likelihood of PE in high risk patients.

By: Dr. Hetoum Misirliyan

(Image from Core Ultrasound)