Review article: Accuracy of emergency physician performed point-of-care ultrasound of the thoracic aorta: A systematic review and narrative synthesis of the literature
Corresponding Author
William Thomas MBBS, GradDipSurgAnat, GradCertClinUS
Surgical Resident
St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Correspondence: Dr William Thomas, Emergency Department, Frankston Hospital, 2 Hastings Road, Frankston, VIC 3199, Australia. Email: [email protected]
Search for more papers by this authorJonathan Henry MBChB, MClinUS, CCPU, AFRACMA, FACEM
Emergency Physician
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Search for more papers by this authorJay Ee Chew MD
Medical Intern
Albury Wodonga Health, Albury, New South Wales, Australia
Search for more papers by this authorManuja Premaratne MBBS, FRACP, FSCCT, FCSANZ
Cardiologist
Monash University, Melbourne, Victoria, Australia
Department of Medicine, Peninsula Health, Melbourne, Victoria, Australia
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Search for more papers by this authorGabriel Blecher MBBS (Hons), PGradDipMan, MSc (Epi), CCPU, FACEM
Emergency Physician
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorDarsim L Haji MBChB, PhD, PGradDipCritCareEcho, FACEM
Emergency Physician
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
William Thomas MBBS, GradDipSurgAnat, GradCertClinUS
Surgical Resident
St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Correspondence: Dr William Thomas, Emergency Department, Frankston Hospital, 2 Hastings Road, Frankston, VIC 3199, Australia. Email: [email protected]
Search for more papers by this authorJonathan Henry MBChB, MClinUS, CCPU, AFRACMA, FACEM
Emergency Physician
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Search for more papers by this authorJay Ee Chew MD
Medical Intern
Albury Wodonga Health, Albury, New South Wales, Australia
Search for more papers by this authorManuja Premaratne MBBS, FRACP, FSCCT, FCSANZ
Cardiologist
Monash University, Melbourne, Victoria, Australia
Department of Medicine, Peninsula Health, Melbourne, Victoria, Australia
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Search for more papers by this authorGabriel Blecher MBBS (Hons), PGradDipMan, MSc (Epi), CCPU, FACEM
Emergency Physician
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorDarsim L Haji MBChB, PhD, PGradDipCritCareEcho, FACEM
Emergency Physician
Emergency Department, Peninsula Health, Melbourne, Victoria, Australia
Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Search for more papers by this authorAbstract
Point-of-care ultrasound (POCUS) is becoming ubiquitous in emergency medicine. POCUS for abdominal aortic aneurysm is well established in practice. The thoracic aorta can also be assessed by POCUS for dissection and aneurysm and transthoracic echocardiography is endorsed by international guidelines as an initial test for thoracic aortic pathologies. A systematic search of Ovid Medline, PubMed, EMBASE, SCOPUS and Web of Science from January 2000 to August 2022 identified four studies evaluating diagnostic accuracy of emergency physician POCUS for thoracic aortic dissection (TAD) and five studies for thoracic aortic aneurysm (TAA). Study designs were heterogeneous including differing diagnostic criteria for aortic pathology. Convenience recruitment was frequent in prospective studies. Sensitivity and specificity ranges for studies of TAD were 41–91% and 94–100%, respectively when an intimal flap was seen. Sensitivity and specificity ranges for studies of thoracic aorta dilation >40 mm were 50–100% and 93–100%, respectively; for >45 mm ranges were 64–65% and 95–99%. Literature review identified that POCUS is specific for TAD and TAA. POCUS reduces the time to diagnosis of thoracic aortic pathology; however, it remains insensitive and cannot be recommended as a stand-alone rule-out test. We suggest that detection of thoracic aorta dilation >40 mm by POCUS at any site increases the suspicion of serious aortic pathology. Studies incorporating algorithmic use of POCUS, Aortic Dissection Detection Risk Score and D-dimer as decision tools are promising and may improve current ED practices. Further research is warranted in this rapidly evolving field.
Open Research
Data availability statement
The data that supports the findings of the present study are available in the supplementary material of this article.
Supporting Information
| Filename | Description |
|---|---|
| emm14262-sup-0001-Appendix1.docxWord 2007 document , 28.3 MB | Appendix S1. Cineloop example findings in point-of-care ultrasound of the thoracic aorta. |
| emm14262-sup-0002-Appendix2.pdfPDF document, 39 KB | Appendix S2. Search strategy for systematic review. |
| emm14262-sup-0003-Appendix3.pdfPDF document, 104.3 KB | Appendix S3. QUADAS-2 bias risk assessment of emergency physician point-of-care ultrasound studies for thoracic aorta dissection. |
| emm14262-sup-0004-Appendix4.pdfPDF document, 104.4 KB | Appendix S4. QUADAS-2 bias risk assessment of EP POCUS studies for thoracic aorta dilation and aneurysm. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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