Importance of transthoracic echocardiography practised in emergency departments by the emergency physician in the management of patients and their referral to specialised departments

Key Words: transthoracic echocardiography -emergency physician -management Objective: The aim of this study is to assess the importance of transthoracic echocardiographic examination (TTE) to the emergency physician in the... [ view full abstract ]

Key Words: transthoracic echocardiography -emergency physician -management

Objective: The aim of this study is to assess the importance of transthoracic echocardiographic examination (TTE) to the emergency physician in the management of patients admitted to emergency departments and in their subsequent referral to specialised centres.

Material and methods: This randomized prospective study was carried out in the emergency department over 3 months, involving patients presenting an acute chest pain or severe dyspnea or a state of non-traumatic shock. All patients had the benefit of echocardiography performed by a previously trained emergency physician in Doppler echocardiography. As evaluation criteria, we adopted in the first place the changes that had to be made after echocardiographic examination on the level of diagnosis, therapeutic approach and referral of patients to concerned departments. As a secondary criterion, we chose the agreement of the diagnosis made in the emergency department with the final diagnosis.

Results : We realised 64 transthoracic echocardiographic examinations. As a result the diagnosis had to be changed in 30% of cases, the therapeutic approach was corrected in 41% of cases and the patient had to be referred to a different department in 19% of cases.
The findings were in accordance with the final diagnosis made in hospital (based on the hospitalisation report) in 92% of inpatients. Thus, we obtained a sensitivity of 87%, a specificity of 95%, a positive predictive value of 97% and a negative predictive value of 87% of TTE against the initial diagnosis made.

Conclusion : Transthoracic echocardiography can be a useful and reliable tool in the hands of emergency physicians. It should be an integral part of the investigations procedures used in emergency departments, but should by no means replace a detailed physical examination and the other routine special investigations undertaken in emergency departments.