The Diagnostic Value of Bedside Ultrasound in Patients Presenting to the Emergency Department with Shock Symptoms
Project no. 116 · Status: Kapanmış · 2017
Summary
Background: Shock is a condition of circulatory failure that creates an imbalance between tissue oxygen supply and oxygen demand. Hypovolemic, cardiogenic, obstructive, and distributive conditions cause shock. This study, it was aimed to evaluate the efficacy of the only clinical approach and clinical and RUSH protocol approaches in distinguishing the shock types of patients admitted to the emergency department with shock. Methods: A prospective, observational analytical study was planned. Patients with systolic blood pressure <90 mmHg and shock index> 1 and who applied to the Emergency Department of Ege University Medical Faculty Hospital between June 2018 and June 2020, were included in the study. Patients who were pregnant, under 18 years of age, undergoing resuscitation, had ST elevation on the ECGs, were examined from an external center and had a definite final diagnosis, and had obvious shock etiology were excluded from the study. The RUSH protocol was practiced after evaluating the history and physical examination findings by the Emergency Department physicians and making a pre-diagnosis for the patient. The pre-diagnosis occurred after the RUSH protocol was recorded. After completing the evaluation, the final diagnoses of the patients were recorded on the electronic file system. Sensitivity, specificity, positive predictive value, and negative predictive values of the shock type diagnoses obtained after the clinical and RUSH protocol were calculated according to the final diagnoses. The consistency of the pre-diagnoses formed by clinical evaluation and clinical and RUSH evaluation between the last diagnoses was evaluated with the Kappa test. The situations where the P-value was below 0.05 were considered as statistically significant results. Results: The study population consisted of 102 patients. 54.9% of the patients were male and the mean age was 68.1 ± 14.7. The distributive shock was the most common cause of shock (55.9%). This was followed by cardiogenic (24.5%) and hypovolemic shock (17.6%), respectively. The obstructive shock was determined as the least common type of shock (2%). It was determined that 12.7% (n = 13) of the patients evaluated with clinical diagnosis could not distinguish the type of shock. Considering all causes of shock, Kappa's compliance with the final diagnosis was determined as moderate (0.552) only after clinical evaluation, while this was found to be perfect (0.905) when the clinical and RUSH protocol were evaluated together. When the only clinical evaluation was considered, sensitivity values for hypovolemic, cardiogenic, distributive, and obstructive shock types were 77.7, 76, 54.3, 50, and specificity values were 97.6, 62.2, 73.3, 94, respectively. After clinical + RUSH evaluation, sensitivity values for hypovolemic, cardiogenic, distributive, and obstructive shock types were 100, 92, 92.9, 100, and specificity values were 98.8, 100, 100, 96, respectively. Conclusion: The RUSH protocol contributes to the clinical evaluation in determining the shock type of patients who admitted to the emergency department with shock. This effect is particularly pronounced in patients with distributive, hypovolemic and cardiogenic shock. Emergency physicians should apply the RUSH protocol in patients with hypotensive and poor perfusion findings. Keywords: Shock, ultrasonography, RUSH protocol, emergency medicine