Objective:  Overreliance on technology has led to dwindling physical exam (PE) skills.  We  compared the diagnostic accuracy of a structured lung physical examination (L - PE) to structured  lung ultrasound (LUS) in ED patients with undifferentiated dyspnea. We also exami ned the  change in differential diagnosis and degree of certainty based on order and type of exam Methods:  This was a prospective, randomized, crossover study of a convenience sample of adult  ED patients with undifferentiated dyspnea. Comprehensive L - PE and  LUS were performed in  random order followed by the other exam. An adjudication committee determined the final diagnosis based on all available data and served as the criterion standard. Primary outcome was  diagnostic accuracy. A sample of 86 patients had  80% power to detect a 25% difference in  diagnostic accuracy Results: A total of 102 patients were enrolled.  Similar accuracies were  found between L - PE and 15 LUS for both COPD [75% (95% CI 65 - 83) vs. 76% (95% CI 67 - 84)] and asthma [87% (95% CI 16 79 - 93) vs. 87% (95 CI 79 - 93)]. LUS [81% (95 CI 72 - 88)] was slightly more accurate compared  to L - PE [72% (95 CI 62 - 80)] for diagnosis of pneumonia but not statistically significant. For  patients presenting with pulmonary edema, LUS was  slightly [76% (95 CI 66 - 84)] mo re accurate  than L - PE [73% (95 CI 63 - 81)], but not statistically significant. Finally, f or detecting pleural  effusions, L - PE [96% (95 CI 90 - 99)] was  more accurate than LUS [82% (95 CI 73 - 89)]. Conclusions:  The diagnostic accuracies of comprehensive lung p hysical examination and focused lung  ultrasound were generally similar in ED patients with dyspnea and should be used concurrently  to maximize diagnostic accuracy .

The authors have declared no competing interest.

https://pubmed.ncbi.nlm.nih.gov/26033127/

The author(s) received no specific funding for this work.

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