CompletedNot Applicable

Evaluation of Rapid Emergency Echography for Acute Dyspnoea

France461 participantsStarted 2016-02-29

Plain-language summary

Elderly people constitute the largest proportion of emergency room patients, representing 12% of all emergency room admissions. The need for diagnostic tests or therapeutic interventions is much greater in this patient population. Cardiovascular diseases and symptoms represent 12% of the causes for emergency room admission, and patients suffering from cardiovascular disease are those whose emergency room visit lasts longest. The diagnostic approach in the emergency room in elderly patients admitted for acute dypsnoea is complex, and early identification of acute left-sided heart failure (ALSHF) is vital as it has an impact on prognosis. The clinical signs are difficult to interpret, and are non-specific, particularly at the acute phase and in elderly or obese patients. Indeed, some authors have reported up to 50% of diagnostic errors in elderly patients. Measure of the blood concentration of a natriuretic peptide allows a quick diagnosis. However, peptides suffer from several limitations, particularly in situations that are often encountered in elderly patients, such as sepsis, renal failure, acute coronary syndrome, pulmonary embolism, chronic respiratory failure, atrial fibrillation and high body mass index. Diagnostic performance deteriorates with increasing age, and there is a significant increase in this grey-zone in patients aged ≥75 years. In critical situations in elderly patients, assessment of natriuretic peptides serve mainly to rule out a diagnosis of left heart failure. Some authors have suggested using lung ultrasound in the initial work-up of acute respiratory failure, since some specific profiles are known to be related to the presence of interstitial oedema, reflecting impaired left heart function (e.g. presence of B lines). These studies were performed in the context of intensive or critical care, but data are sparse regarding the application of this approach in the emergency room. The hypothesis is that the diagnostic accuracy of a targeted and quick echographic approach, namely the READ method (Rapid Echography for Acute Dyspnoea), comprising targeted lung ultrasound combined with isolated measure of transmitral flow, would be superior to that of NT-proBNP assessment for the diagnosis of ALSHF in elderly patients (≥75 years) admitted to the emergency department.

Who can participate

Age range

75 Years

Sex

ALL

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AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.

Inclusion Criteria: Admission to the Emergency Department Age ≥ 75 years AND criteria of acute dyspnoea: * Breathe rate ≥ 25 cycles/minute * or PaO2 ≤ 70 mmHg * or SpO2 ≤ 92% in room air * or PacO2 ≥ 45 mmHg and pH ≤ 7.35 AND Electrocardiogram in sinus rhythm or in atrial fibrillation at admission Exclusion Criteria: * Shock i.e. : systolic arterial pressure \<90mmHg; or reduction \>40mmHg or \>30% of usual arterial pressure; or Mean Arterial Pressure \<65mmHG. * Acute respiratory distress ie : Respiratory rate \>30cpm, use of accessory respiratory muscles, SpO2 \<90% when O2 therapy is required, impaired consciousness, * Presence of acute coronary syndrome on the ECG * Other obvious etiological diagnosis (pneumothorax, clinical and radiological manifestations of pneumonia) * Cardiological or respiratory medicine therapies initiated before the READ approach could be put in place (at patient's home, pre-hospital and/or in the emergency department) i.e.. diuretic, vasoactive drugs (nitrovasodilator, sympathomimetic and cardiotonic drugs, vasodilators and vasoconstrictors); or Continuous Positive Airway Pressure (CPAP); or invasive or non-invasive ventilation. * Patient not affiliated to or beneficiary of the French social security system * Protected people (pregnant and lactating women, guardianship, curatorship, under the protection of justice)Subjects in the exclusion period after participation in another clinical trial, or as listed in the national database of health re…

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What they're measuring

To demonstrate the superiority of the READ method over assessment of NT-proBNP for the diagnosis of acute left-sided heart failure in patients aged ≥75 years admitted to the emergency department for acute dyspnoea.

Timeframe: 1 day

Trial details

NCT IDNCT02531542

SponsorCentre Hospitalier Universitaire de Besancon

Sponsor typeOTHER

Study typeINTERVENTIONAL

Primary completion2022-12-20

View on ClinicalTrials.gov More Acute Dyspnea trials