Point-of-Care Lung Ultrasound in Emergency Medicine: A Scoping Review With an Interactive Database

Stig Holm Ovesen; Andreas Hvilshøj Clausen; Hans Kirkegaard; Bo Løfgren; Rasmus Aagaard; Søren Helbo Skaarup; Michael Dan Arvig; Morten Hjarnø Lorentzen; Anne Heltborg Kristensen; Mariana Bichuette Cartuliares; Casper Falster; Liting Tong; Alessandra Rabajoli; Ronja Leth; Janeve Desy; Irene W Y Ma; Jesper Weile

doi:10.1016/j.chest.2024.02.053

Point-of-Care Lung Ultrasound in Emergency Medicine: A Scoping Review With an Interactive Database

Chest. 2024 Mar 7:S0012-3692(24)00290-3. doi: 10.1016/j.chest.2024.02.053. Online ahead of print.

Authors

Stig Holm Ovesen¹, Andreas Hvilshøj Clausen², Hans Kirkegaard³, Bo Løfgren⁴, Rasmus Aagaard⁵, Søren Helbo Skaarup⁶, Michael Dan Arvig⁷, Morten Hjarnø Lorentzen⁸, Anne Heltborg Kristensen⁸, Mariana Bichuette Cartuliares⁸, Casper Falster⁹, Liting Tong¹⁰, Alessandra Rabajoli¹¹, Ronja Leth¹², Janeve Desy¹³, Irene W Y Ma¹⁴, Jesper Weile¹²

Affiliations

¹ Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Emergency Department, Horsens Regional Hospital, Denmark. Electronic address: stigholm@clin.au.dk.
² Emergency Department, Aarhus University Hospital, Denmark.
³ Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital, Denmark; Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University, Denmark.
⁴ Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Department of Internal Medicine, Randers Regional Hospital, Denmark.
⁵ Department of Anesthesiology, Aarhus University Hospital, Denmark.
⁶ Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark.
⁷ Department of Emergency Medicine, Slagelse Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen.
⁸ Department of Emergency Medicine, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark.
⁹ Department of Respiratory Medicine, Odense University Hospital; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark.
¹⁰ Emergency Department, Nykøbing F. Hospital, Zealand Denmark Region.
¹¹ Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
¹² Research Center for Emergency Medicine, Aarhus University Hospital and Aarhus University, Denmark; Emergency Department, Horsens Regional Hospital, Denmark.
¹³ Division of General Internal Medicine, Cumming School of Medicine, University of Calgary; Office of Undergraduate Medical Education, Cumming School of Medicine, University of Calgary.
¹⁴ Division of General Internal Medicine, Cumming School of Medicine, University of Calgary.

PMID: 38458431
DOI: 10.1016/j.chest.2024.02.053

Abstract

Background: This scoping review was conducted to provide an overview of the evidence of point-of-care lung ultrasound (LUS) in emergency medicine. By emphasizing clinical topics, time trends, study designs, and the scope of the primary outcomes, a map is provided for physicians and researchers to guide their future initiatives.

Research question: Which study designs and primary outcomes are reported in published studies of LUS in emergency medicine?

Study design and methods: We performed a systematic search in the PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library databases for LUS studies published prior to May 13, 2023. Study characteristics were synthesized quantitatively. The primary outcomes in all papers were categorized into the hierarchical Fryback and Thornbury levels.

Results: A total of 4,076 papers were screened and, following selection and handsearching, 406 papers were included. The number of publications doubled from January 2020 to May 2023 (204 to 406 papers). The study designs were primarily observational (n = 375 [92%]), followed by randomized (n = 18 [4%]) and case series (n = 13 [3%]). The primary outcome measure concerned diagnostic accuracy in 319 papers (79%), diagnostic thinking in 32 (8%), therapeutic changes in 4 (1%), and patient outcomes in 14 (3%). No increase in the proportions of randomized controlled trials or the scope of primary outcome measures was observed with time. A freely available interactive database was created to enable readers to search for any given interest (https://public.tableau.com/app/profile/blinded/viz/LUSinEM_240216/INFO).

Interpretation: Observational diagnostic studies have been produced in abundance, leaving a paucity of research exploring clinical utility. Notably, research exploring whether LUS causes changes to clinical decisions is imperative prior to any further research being made into patient benefits.

Keywords: emergency medicine; lung ultrasound; respiratory symptoms.