Background: The diagnosis of patients with acute dyspnoea is challenging, as clinical history and physical examination are often nondiagnostic and inaccurate. Consequently, clinicians often rely on the results of chest radiography (CXR) to determine the initial intervention and guide further treatment.
Objective: The purpose of this study was to prospectively assess the sensitivity and specificity of ultrasonographic assessment of jugular venous distension (US-JVD) for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure.
Measurements: US-JVD was compared with initial CXR findings of pulmonary oedema as determined by radiology consultants blinded to all clinical information and US-JVD measurements.
Results: US-JVD had a sensitivity of 98.2% [95% confidence interval (CI), 89.2–99.9] and a specificity of 42.9% (95% CI, 30.7–55.9), a likelihood ratio positive of 1.7 (95% CI, 1.4–2.1), and likelihood ratio negative of 0.04 (95% CI, 0.006–0.3), for identifying dyspnoeic patients with pulmonary oedema on initial CXR.
Conclusion: US-JVD is a sensitive test for identifying pulmonary oedema on CXR in dyspnoeic patients with suspected congestive heart failure.
aDavid Geffen School of Medicine at UCLA
bDivision of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
cHarbor-UCLA Medical Center, Department of Emergency Medicine
dLA Biomed Research Institute, Carson St Torrance, California, USA
Correspondence to Dr Timothy Jang, MD, David Geffen School of Medicine at UCLA and Harbor-UCLA Medical Center, 1000 W. Carson St, D-9A, Torrance, CA 90502, USA Tel: +1 310 222 3500; fax: +1 310 212 6101; e-mail: firstname.lastname@example.org
Received November 19, 2009
Accepted April 19, 2010