A Comparison of the Diagnostic Value of Multiorgan Point-of-care Ultrasound between High-risk and Medium-to-low-risk Pulmonary Embolism Cases.

Abstract

Objective: This study aimed to explore the diagnostic value of multiorgan (heart, lungs, blood vessels) point-of-care ultrasound (PoCUS) in patients with high-risk and medium-to-low-risk pulmonary embolism (PE).

Methods: Clinical data of 92 patients with suspected PE, admitted to Hangzhou TCM Hospital affiliated with Zhejiang Chinese Medical University from July 2021 to June 2023, were retrospectively analyzed. According to hemodynamic status, patients were divided into the high-risk (n=28) and the medium-to-low-risk groups (n=64). Using computed tomography (CT) and pulmonary angiography (CTPA) as the gold standard, all patients underwent multiorgan PoCUS examination. The sensitivity, specificity, and accuracy of different methods for diagnosing PE, as well as the time difference between multiorgan PoCUS examination and CTPA, were compared. Differences in measurement values of relevant indicators in all groups were analyzed.

Results: In the high-risk group of patients, CTPA identified 15 cases of PE. In contrast, the PoCUS examination confirmed PE diagnosis in 14 cases (true positive), while 10 cases were diagnosed as true negative, one case as false negative, and three cases as false positive. In the medium-to-low-risk group, CTPA identified 50 patients with PE, while multiorgan PoCUS confirmed PE diagnosis in 33 cases (true positive), and identified 9 true negative, 17 false negative, and 5 false positive PE cases. Kappa test of the consistency between the results of multiorgan PoCUS and CTPA showed that multiorgan PoCUS had higher sensitivity, negative predictive value, and accuracy in the high-risk group compared to the medium-tolow- risk group (p<0.05). Cohen's Kappa value of the high-risk group was 0.710, indicating moderate consistency between PoCUS and CTPA results, while Cohen's Kappa value of 0.231 for the medium and low-risk group indicated poor consistency. There was a significant difference in ultrasound parameters between the high-risk and the medium-to-low-risk group (p<0.05). The time required for multiorgan PoCUS in both groups was significantly shorter than that for the CTPA. There was no significant difference in the time required for PoCUS between the two groups (p>0.05).

Conclusion: Multiorgan PoCUS has been found to have higher sensitivity and accuracy in diagnosing patients with high-risk PE compared to those with medium-to-low-risk PE, and a shorter imaging time compared to CTPA.