Accuracy of Rapid Ultrasound in Shock (RUSH) Exam for Diagnosis of Shock in Critically Ill Patients

Abstract

Background:Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame.Objectives:In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients.Patients and Methods:An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case.Results:We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97% yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100% but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush.Conclusions:This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients.

Ultrasound in undergraduate medical education: a systematic and critical review

“…There is evidence to support the improved safety of certain procedures with POCUS . It has also been shown to assist with certain diagnoses at the bedside, and can rapidly and accurately identify anatomic pathology . However, there remains a lack of sufficient evidence to support any clear clinical benefit of even the longest‐studied diagnostic application of POCUS (i.e.…”

“…[7][8][9] It has also been shown to assist with certain diagnoses at the bedside, and can rapidly and accurately identify anatomic pathology. [10][11][12][13] However, there remains a lack of sufficient evidence to support any clear clinical benefit of even the longest-studied diagnostic application of POCUS (i.e. the focused assessment with sonography in trauma [FAST] examination in blunt abdominal trauma).…”

Paramedic point of care ultrasound at Australian mass gatherings

“…Physical examination, vital signs and ECG were unremarkable (aside from a suspicion of alcohol and illicit substance intoxication). A RUSH examination (rapid ultrasound for shock and hypotension) was performed which found a completely collapsing inferior vena cava on spontaneous respiration and normal gross left ventricular function. A fluid challenge and 1 h of observation resulted in improved volaemic status (assessed clinically and on ultrasound); they were eventually discharged home with responsible friends later that evening after regaining an acceptable level of consciousness.…”

Az ágy melletti ultrahangvizsgálat diagnosztikus lehetőségeinek vizsgálata a sürgősségi betegellátásban

“…A sokkos beteg elsődleges vizsgálata során alkalmazott célzott, percek alatt elvégezhető és nem feltétlenül radiológus által végzett UH-vizsgálat javítja az iránydiagnó-zisok pontosságát és a betegellátás hatékonyságát. M. R. Ghane és mtsai egy 2015-ben megjelent tanulmányban azt találták, hogy a RUSH különösen megbízható a kardiogén, obstruktív és hypovolaemiás sokk kizárására [18]. Lényeges szempont az is, hogy ehhez a beteg kü-lön szállítást nem igényel és a vizsgálat tetszés szerint megismételhető (például egy megkezdett diuretikus vagy pozitív inotrop kezelés hatékonysága gyorsan ellenőrizhető).…”

“…Hangsúlyozandó, hogy egy ilyen összetett, tünetorientált UH-alkalmazás a klinikus kezében akkor igazán hatásos differenciáldiag-nosztikai eszköz, ha tudja, mit keres és a felmerülő kór-képek spektrumát szűkíteni képes. Szintén M. R. Ghane és mtsai hasonlították össze a sürgősségi orvos és radiológus által végzett RUSH-protokoll eredményeit és nem találtak szignifikáns különbséget [18]. Szakmák közötti egyeztetést követően európai és tengerentúli minták alapján a sürgősségi ágy melletti UH moduljainak szakképzésbe építése megfontolandó.…”