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Performance of bedside lung ultrasound in emergency (BLUE) protocol in the diagnosis of pneumonia

Aussagekraft des Protokolls für den bettseitigen Lungenultraschall im Notfall (BLUE) in der Pneumoniediagnostik

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Abstract

Purpose

Although the diagnostic performance of the bedside lung ultrasound emergency (BLUE) protocol has been well-studied in patients with undifferentiated dyspnea, the data on performance of the BLUE protocol and associated ultrasound artifacts for the diagnosis of pneumonia are limited. This study aimed to determine the performance of the BLUE protocol and each of the BLUE protocol profiles in the diagnosis of pneumonia in the emergency department (ED).

Methods

Patients admitted to the ED with the symptoms suggesting pneumonia were included. The BLUE protocol was performed by an operator who was blinded to clinical information. Primary outcome was the diagnostic performance of the BLUE protocol for pneumonia. Secondary outcome was the diagnostic contribution of each BLUE protocol profile supporting pneumonia.

Results

Of the 154 patients included in the study, 112 (72.7%) were diagnosed with pneumonia. The BLUE protocol was able to detect pneumonia in 97 (86.6%) patients with a sensitivity of 86.6%, specificity of 71.4%, and LR+ of 3.03. Among the BLUE protocol profiles, the A/B profile had the highest diagnostic performance with a sensitivity, specificity and LR+ of 48.2, 97.6, and 20.3, respectively.

Conclusion

The BLUE protocol had a good diagnostic performance for pneumonia. Among the BLUE protocol profiles, the A/B profile had the highest performance for confirming pneumonia in the ED.

Zusammenfassung

Hintergrund

Obwohl die diagnostische Aussagekraft des BLUE-Protokolls (Protokoll für die bettseitige Anwendung des Lungenultraschalls in Notfallsituationen) bei Patienten mit undifferenzierter Dyspnoe gut untersucht ist, sind die Daten zur Aussagekraft des Protokolls und zu assoziierten Ultraschallartefakten im Zusammenhang mit der Diagnose einer Pneumonie begrenzt. Diese Studie zielte darauf ab, die Aussagekraft des BLUE-Protokolls und jedes der BLUE-Protokoll-Profile bezüglich der Diagnose einer Pneumonie in der Notaufnahme zu bestimmen.

Methoden

In die Notaufnahme aufgenommene Patienten mit Symptomen, die auf eine Pneumonie hindeuten, wurden in die Studie eingeschlossen. Das BLUE-Protokoll wurde von einem Bediener durchgeführt, der für klinische Informationen verblindet war. Primärer Endpunkt war die diagnostische Aussagekraft des BLUE-Protokolls für Pneumonie. Sekundärer Endpunkt war der diagnostische Beitrag jedes BLUE-Protokoll-Profils zum Nachweis einer Pneumonie.

Ergebnisse

Bei 112 (72,7 %) der 154 in die Studie eingeschlossenen Patienten wurde eine Pneumonie diagnostiziert. Das BLUE-Protokoll konnte bei 97 (86,6 %) Patienten eine Pneumonie mit einer Sensitivität von 86,6 %, einer Spezifität von 71,4 % und einem „positive likelihood ratio“ (LR+) von 3,03 nachweisen. Unter den BLUE-Protokoll-Profilen hatte das A/B-Profil die höchste diagnostische Aussagekraft mit einer Sensitivität von 48,2 %, einer Spezifität von 97,6 % und einem LR+ von 20,3.

Schlussfolgerung

Das BLUE-Protokoll hatte eine gute diagnostische Aussagekraft bei Pneumonie. Unter den BLUE-Protokoll-Profilen hatte das A/B-Profil die höchste Aussagekraft hinsichtlich der Bestätigung einer Pneumonie in der Notaufnahme.

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Authors and Affiliations

  1. Faculty of Medicine, Department of Emergency Medicine, Kocaeli University, Kocaeli, Turkey

    Doğan Karademir, Serkan Yılmaz, İbrahim Ulaş Özturan, Nurettin Özgür Doğan, Elif Yaka & Murat Pekdemir

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  1. Doğan Karademir
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  2. Serkan Yılmaz
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  3. İbrahim Ulaş Özturan
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  4. Nurettin Özgür Doğan
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  5. Elif Yaka
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  6. Murat Pekdemir
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Corresponding author

Correspondence to İbrahim Ulaş Özturan.

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Conflict of interest

D. Karademir, S. Yılmazv, İ.U. Özturan, N.Ö. Doğan, E. Yaka and M. Pekdemir declare that they have no competing interests.

Approval was obtained from the ethics committee of Kocaeli University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Karademir, D., Yılmaz, S., Özturan, İ.U. et al. Performance of bedside lung ultrasound in emergency (BLUE) protocol in the diagnosis of pneumonia. Notfall Rettungsmed 24 (Suppl 1), 9–14 (2021). https://doi.org/10.1007/s10049-021-00967-w

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