Abstract：
BACKGROUND: Lung ultrasound (LUS) reduces time to diagnosis and treatment of acute decompensated heart failure (ADHF) in emergency department (ED) patients with undifferentiated dyspnea. We conducted a systematic review to evaluate the diagnostic accuracy and clinical impact of LUS for ADHF in the prehospital setting.
METHODS: We performed a keyword search of multiple databases from inception through June 1, 2023. Included studies were those enrolling prehospital patients with undifferentiated dyspnea or suspected ADHF, and specifically diagnostic studies comparing prehospital LUS to a gold standard and intervention studies with a non-US comparator group. Title and abstract screening, full text review, risk of bias (ROB) assessments, and data extraction were performed by multiple authors. and adjudicated. The primary outcome was pooled sensitivity, specificity, and diagnostic likelihood ratios (LR) for prehospital LUS. A test-treatment threshold of 0.7 was applied based on prior ADHF literature in the ED. Intervention outcomes included mortality, mechanical ventilation, and time to HF specific treatment.
RESULTS: Eight diagnostic studies (n = 691) and two intervention studies (n = 70) met inclusion criteria. No diagnostic studies were low-ROB. Both intervention studies were critical-ROB, and not pooled. Pooled sensitivity and specificity of prehospital LUS for ADHF were 86.7% (95%CI:70.8%-94.6%) and 87.5% (78.2%-93.2%), respectively, with similar performance by physician vs. paramedic LUS and number of lung zones evaluated. Pooled LR+ and LR- were 7.27 (95% CI: 3.69-13.10) and 0.17 (95% CI: 0.06-0.34), respectively. Area under the summary receiver operating characteristic curve was 0.922. At the observed 42.4% ADHF prevalence (pre-test probability), positive pre-hospital LUS exceeded the 70% threshold to initiate treatment (post-test probability 84%, 80-88%).
CONCLUSIONS: LUS had similar diagnostic test characteristics for ADHF diagnosis in the prehospital setting as in the ED. A positive prehospital LUS may be sufficient to initiate early ADHF treatment based on published test-treatment thresholds. More studies are needed to determine the clinical impact of prehospital LUS.
METHODS: We performed a keyword search of multiple databases from inception through June 1, 2023. Included studies were those enrolling prehospital patients with undifferentiated dyspnea or suspected ADHF, and specifically diagnostic studies comparing prehospital LUS to a gold standard and intervention studies with a non-US comparator group. Title and abstract screening, full text review, risk of bias (ROB) assessments, and data extraction were performed by multiple authors. and adjudicated. The primary outcome was pooled sensitivity, specificity, and diagnostic likelihood ratios (LR) for prehospital LUS. A test-treatment threshold of 0.7 was applied based on prior ADHF literature in the ED. Intervention outcomes included mortality, mechanical ventilation, and time to HF specific treatment.
RESULTS: Eight diagnostic studies (n = 691) and two intervention studies (n = 70) met inclusion criteria. No diagnostic studies were low-ROB. Both intervention studies were critical-ROB, and not pooled. Pooled sensitivity and specificity of prehospital LUS for ADHF were 86.7% (95%CI:70.8%-94.6%) and 87.5% (78.2%-93.2%), respectively, with similar performance by physician vs. paramedic LUS and number of lung zones evaluated. Pooled LR+ and LR- were 7.27 (95% CI: 3.69-13.10) and 0.17 (95% CI: 0.06-0.34), respectively. Area under the summary receiver operating characteristic curve was 0.922. At the observed 42.4% ADHF prevalence (pre-test probability), positive pre-hospital LUS exceeded the 70% threshold to initiate treatment (post-test probability 84%, 80-88%).
CONCLUSIONS: LUS had similar diagnostic test characteristics for ADHF diagnosis in the prehospital setting as in the ED. A positive prehospital LUS may be sufficient to initiate early ADHF treatment based on published test-treatment thresholds. More studies are needed to determine the clinical impact of prehospital LUS.
摘要：
背景：肺超声（LUS）缩短了急诊（ED）未分化呼吸困难患者的急性失代偿性心力衰竭（ADHF）的诊断和治疗时间。我们进行了系统评价，以评估LUS在院前环境中对ADHF的诊断准确性和临床影响。
方法：我们从初始到2023年6月1日对多个数据库进行了关键字搜索。纳入的研究包括院前未分化呼吸困难或疑似ADHF的患者，特别是将院前LUS与金标准进行比较的诊断性研究和与非美国比较组进行的干预性研究。标题和摘要筛选，全文回顾,偏见风险(ROB)评估，数据提取由多位作者完成.并裁决。主要结果是汇集敏感性，特异性，和院前LUS的诊断似然比（LR）。基于ED中先前的ADHF文献,应用0.7的测试处理阈值。干预结果包括死亡率，机械通气,和HF特异性治疗的时间。
结果：8项诊断研究（n=691）和2项干预研究（n=70）符合纳入标准。没有低ROB的诊断研究。两项干预研究都是关键的-ROB，而不是集合。院前LUS对ADHF的敏感性和特异性分别为86.7%(95CI:70.8%-94.6%)和87.5%(78.2%-93.2%),分别,医生与医生的表现相似护理人员LUS和评估的肺区数量。汇总LR+和LR-分别为7.27(95%CI:3.69-13.10)和0.17(95%CI:0.06-0.34)，分别。汇总受试者工作特征曲线下面积为0.922。在观察到的42.4％ADHF患病率（测试前概率），院前LUS阳性超过开始治疗的70%阈值(测试后概率84%，80-88%）。
结论：LUS在院前诊断ADHF的诊断测试特征与ED相似。基于已发布的测试治疗阈值，院前LUS阳性可能足以启动早期ADHF治疗。需要更多的研究来确定院前LUS的临床影响。
方法：我们从初始到2023年6月1日对多个数据库进行了关键字搜索。纳入的研究包括院前未分化呼吸困难或疑似ADHF的患者，特别是将院前LUS与金标准进行比较的诊断性研究和与非美国比较组进行的干预性研究。标题和摘要筛选，全文回顾,偏见风险(ROB)评估，数据提取由多位作者完成.并裁决。主要结果是汇集敏感性，特异性，和院前LUS的诊断似然比（LR）。基于ED中先前的ADHF文献,应用0.7的测试处理阈值。干预结果包括死亡率，机械通气,和HF特异性治疗的时间。
结果：8项诊断研究（n=691）和2项干预研究（n=70）符合纳入标准。没有低ROB的诊断研究。两项干预研究都是关键的-ROB，而不是集合。院前LUS对ADHF的敏感性和特异性分别为86.7%(95CI:70.8%-94.6%)和87.5%(78.2%-93.2%),分别,医生与医生的表现相似护理人员LUS和评估的肺区数量。汇总LR+和LR-分别为7.27(95%CI:3.69-13.10)和0.17(95%CI:0.06-0.34)，分别。汇总受试者工作特征曲线下面积为0.922。在观察到的42.4％ADHF患病率（测试前概率），院前LUS阳性超过开始治疗的70%阈值(测试后概率84%，80-88%）。
结论：LUS在院前诊断ADHF的诊断测试特征与ED相似。基于已发布的测试治疗阈值，院前LUS阳性可能足以启动早期ADHF治疗。需要更多的研究来确定院前LUS的临床影响。
