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)

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.