Peer Reviewed

Dyspnea

ACP Updates Acute Dyspnea Recommendations

In a new clinical guideline, the American College of Physicians (ACP) has recommended the use of point-of-care ultrasonography (POCUS) in patients with acute dyspnea in emergency department or inpatient settings.1

The conditional recommendation states that POCUS should be used to supplement the standard diagnostic testing in effort to improve the care of those with uncertain diagnosis.

The guideline follows a systematic review which used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Included were patient values and preferences, as well as the benefits, harms, test accuracy, and cost of POCUS.

Among the aspects examined:

  • In-hospital mortality
  • Time to diagnosis
  • Time to treatment
  • Intensive care unit admissions
  • Accuracy of diagnosis
  • Disease-specific outcomes
  • Hospital readmissions
  • Length of hospital stay
  • Quality of life

 

“Point-of-care ultrasonography, when added to a standard diagnostic pathway, let to statistically more correct diagnoses in patients with dyspnea than the standard diagnostic pathway alone,” the panel wrote in an evidence report.2 “In-hospital mortality and length of hospital stay did not differ significantly between patients who did or did not receive POCUS in addition to standard diagnostic tests. Finally, POCUS consistently improved the sensitivities of standard diagnostic pathways to detect congestive heart failure, pneumonia, pulmonary embolism, pleural effusion, or pneumothorax; specificities increased in most but not all studies.”

 

—Leigh Precopio

 

References:

  1. Qaseem A, Etzeandia-Ikobaltzeta I, Mustafa RA, Kansagara D, Fitterman N, Wilt TJ; Clinical Guidelines Committee of the American College of Physicians. Appropriate use of point-of-care ultrasonography in patients with acute dyspnea in emergency department of inpatient settings: a clinical guidelines from the American College of Physicians. Ann Intern Med. Published online April 27, 2021. https://doi.org/10.7326/M20-7844
  2. Gartlehner G, Wagner G, Affengruber L, et al. Point-of-care ultrasonography in patients with acute dyspnea: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med. Published online April 27, 2021. https://doi.org/10.7326/M20-5504