B-lines Ultrasonography Assessment by Nurses for the Diagnosis of Heart Failure in the Emergency Department

Abstract

Introduction: The use of lung ultrasonography (LUS) for B-lines quantification has been shown to be pivotal in the rapid diagnostic of heart failure (HF). It has even been suggested that nurses can perform this test accurately. Aims: Our study aimed to evaluate the accuracy and reproducibility of B-line quantification by emergency medicine (EM) nurses after 12-hour training in the diagnosis of HF in patients admitted to the emergency department (ED) with acute dyspnea.

Methods: This prospective cross-sectional study included 216 patients admitted to the ED with a chief complaint of acute dyspnea, conducted between January 2018 and 2019. LUS was performed by EM nurses and a trained emergency physician. The participating nurses completed a 12-hour structured LUS training course. The LUS score was calculated. The diagnosis of heart failure was the judgment of blinded expert emergency physician unaware of the lung ultrasound findings. The agreement between physicians and nurses was assessed, and the diagnostic performance of the LUS score was evaluated by the area under the receiver operating characteristic (ROC) curve.

Results: In total, 216 patients with acute dyspnea were screened. There was good agreement between nurses and physicians regarding the diagnosis of HF (kappa value = 0.787). The discriminating power of the LUS score calculated by emergency physicians and nurses was good (area under the ROC curve of 0.8 and 0.73, respectively).

Conclusion: In our study, we have shown that following LUS short-course training, EM nurses could reliably diagnose HF in patients presenting to the ED with undifferentiated dyspnea.