Diagnostic accuracy of a bespoke multiorgan ultrasound approach in suspected pulmonary embolism

Background: CT pulmonary angiography and V/Q-scan are considered reference standards in the diagnosis of pulmonary embolism but are hindered by several contraindications and expose the patients to radiation.The aims of this study were to prospectively validate the diagnostic accuracy of a bespoke multiorgan point-of-care ultrasound approach, and evaluate if this model allows reduced referral to further radiation diagnostics while maintaining safety standards.Methods: Patients with suspected pulmonary embolism referred for CT pulmonary angiography or V/Q-scan were included as a convenience sample. All patients were subject to blinded ultrasound investigation with cardiac, lung and deep venous ultrasound. Sensitivity and specificity of applied ultrasound signs and the hypothetical reduction in need for further diagnostic work-up was calculated.Results: Seventy-five patients were prospectively enrolled. Prevalence of pulmonary embolism was 28%. Most notable ultrasound signs were presence of a deep venous thrombus, at least two hypoechoic pleural based lesions, the D-sign, the 60/60-sign and a visible right ventricular thrombus which all had a specificity of a 100%. Additionally, a multiorgan ultrasound investigation with no findings compatible with pulmonary embolism yielded a sensitivity of 95.2% (95%CI: 76.2-99.9). CT or scintigraphy could be safely avoided in 70% of cases (95%CI: 63.0-83.1%).Interpretation: The findings of our study suggest that implementation of a multiorgan ultrasound assessment in patients with suspected pulmonary embolism may reduce the need for CT or scintigraphy by confirming or dismissing the suspicion.FootnotesCite this article as Eur Respir J 2022; 60: Suppl. 66, 905.This article was presented at the 2022 ERS International Congress, in session “-”.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).