Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol
Introduction Dyspnoea frequently leads to admissions in the Emergency Department (ED). Rapid and accurate diagnosis, specifically to distinguish acute heart failure from pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD), is imperative to initiate appropriate therapy. This s...
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| Format: | Article |
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BMJ Publishing Group
2025-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/8/e101432.full |
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| author | Adrien Bassand Tahar Chouihed Nicolas Girerd Xavier Lepage Ludovic Merckle Anthony Chauvin Aurélien Buessler Deborah Jaeger Kevin Duarte Charlene Duchanois Jérôme Bokobza Alice Penine Gaetan Giacomin Cyrielle Brossard |
| author_facet | Adrien Bassand Tahar Chouihed Nicolas Girerd Xavier Lepage Ludovic Merckle Anthony Chauvin Aurélien Buessler Deborah Jaeger Kevin Duarte Charlene Duchanois Jérôme Bokobza Alice Penine Gaetan Giacomin Cyrielle Brossard |
| author_sort | Adrien Bassand |
| collection | DOAJ |
| description | Introduction Dyspnoea frequently leads to admissions in the Emergency Department (ED). Rapid and accurate diagnosis, specifically to distinguish acute heart failure from pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD), is imperative to initiate appropriate therapy. This study aims to evaluate the feasibility and performance of the EMERgency ALgorithm efficiency for Dyspneic patient-UltraSound (EMERALD-US) algorithm using ultrasound (US) to diagnose the etiology of dyspnea in the ED-admitted patients.Method and analysis 225 patients of 50 years and above, presenting with acute non-traumatic dyspnoea, across six participating EDs will be enrolled. Patients will undergo a lung, a simplified four-chamber cardiac and a venous US. A physician, blinded to any clinical data or previous results, will execute the algorithm. The algorithm’s performance will be assessed using a receiver operating characteristic (ROC) curve. Secondary objectives include an evaluation of the protocol’s feasibility in the ED, an assessment of the concordance between the EMERALD-US algorithm diagnoses and results from other diagnostic tests (including laboratory work and imaging), as well as an evaluation of the algorithm’s performance in diagnosing other causes of dyspnoea, such as pulmonary embolism or pleural effusion, and the 30-day mortality rate.Ethics and dissemination The study protocol was approved by the French Committee for the Protection of Persons (CPP) (RCB n°2018-A02136-49). Misdiagnosis of dyspneic patients on ED admission has been associated with inappropriate treatment, prolonged hospital stays and increased mortality, particularly among elderly patients. The implementation of protocols like the EMERALD-US algorithm can help physicians in expedited decision-making and diagnosis without increasing ED visit durations.Trial registration number NCT03691857. |
| format | Article |
| id | doaj-art-edf3ccbf81e74f6f9240ce897ab8f8d6 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-edf3ccbf81e74f6f9240ce897ab8f8d62025-08-20T03:59:45ZengBMJ Publishing GroupBMJ Open2044-60552025-08-0115810.1136/bmjopen-2025-101432Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocolAdrien Bassand0Tahar Chouihed1Nicolas Girerd2Xavier Lepage3Ludovic Merckle4Anthony Chauvin5Aurélien Buessler6Deborah Jaeger7Kevin Duarte8Charlene Duchanois9Jérôme Bokobza10Alice Penine11Gaetan Giacomin12Cyrielle Brossard13Lorraine University, Emergency Department, University Hospital of Nancy, Nancy, Lorraine, FranceLorraine University, Emergency Department, University Hospital of Nancy, Nancy, Lorraine, FranceLorraine University, CIC-P, University Hospital of Nancy, Vandoeuvre les Nancy, Lorraine, FranceLorraine University, CIC-P, University Hospital of Nancy, Vandoeuvre les Nancy, Lorraine, FranceLorraine University, CIC-P, University Hospital of Nancy, Vandoeuvre les Nancy, Lorraine, FranceEmergency Department, Assistance Publique - Hopitaux de Paris, Lariboisière Hospital, Paris, FranceLorraine University, Emergency Department, University Hospital of Nancy, Nancy, Lorraine, FranceLorraine University, Emergency Department, University Hospital of Nancy, Nancy, Lorraine, FranceLorraine University, CIC-P, University Hospital of Nancy, Vandoeuvre les Nancy, Lorraine, FranceLorraine University, Emergency Department, University Hospital of Nancy, Nancy, Lorraine, FranceAdult Emergency Department, Assistance Publique Hôpitaux de Paris, Hopital Cochin, Paris, FranceEmergency Department, Charleville-Maizières Hospital, Charleville Maizières, FranceLorraine University, Emergency Department, University Hospital of Nancy, Nancy, Lorraine, FranceEmergency Department, CHR Metz-Thionville, Metz, Lorraine, FranceIntroduction Dyspnoea frequently leads to admissions in the Emergency Department (ED). Rapid and accurate diagnosis, specifically to distinguish acute heart failure from pneumonia and exacerbations of chronic obstructive pulmonary disease (COPD), is imperative to initiate appropriate therapy. This study aims to evaluate the feasibility and performance of the EMERgency ALgorithm efficiency for Dyspneic patient-UltraSound (EMERALD-US) algorithm using ultrasound (US) to diagnose the etiology of dyspnea in the ED-admitted patients.Method and analysis 225 patients of 50 years and above, presenting with acute non-traumatic dyspnoea, across six participating EDs will be enrolled. Patients will undergo a lung, a simplified four-chamber cardiac and a venous US. A physician, blinded to any clinical data or previous results, will execute the algorithm. The algorithm’s performance will be assessed using a receiver operating characteristic (ROC) curve. Secondary objectives include an evaluation of the protocol’s feasibility in the ED, an assessment of the concordance between the EMERALD-US algorithm diagnoses and results from other diagnostic tests (including laboratory work and imaging), as well as an evaluation of the algorithm’s performance in diagnosing other causes of dyspnoea, such as pulmonary embolism or pleural effusion, and the 30-day mortality rate.Ethics and dissemination The study protocol was approved by the French Committee for the Protection of Persons (CPP) (RCB n°2018-A02136-49). Misdiagnosis of dyspneic patients on ED admission has been associated with inappropriate treatment, prolonged hospital stays and increased mortality, particularly among elderly patients. The implementation of protocols like the EMERALD-US algorithm can help physicians in expedited decision-making and diagnosis without increasing ED visit durations.Trial registration number NCT03691857.https://bmjopen.bmj.com/content/15/8/e101432.full |
| spellingShingle | Adrien Bassand Tahar Chouihed Nicolas Girerd Xavier Lepage Ludovic Merckle Anthony Chauvin Aurélien Buessler Deborah Jaeger Kevin Duarte Charlene Duchanois Jérôme Bokobza Alice Penine Gaetan Giacomin Cyrielle Brossard Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol BMJ Open |
| title | Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol |
| title_full | Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol |
| title_fullStr | Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol |
| title_full_unstemmed | Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol |
| title_short | Performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department: an EMERALD-US protocol |
| title_sort | performance of an ultrasound diagnostic algorithm for acute dyspneic patients in the emergency department an emerald us protocol |
| url | https://bmjopen.bmj.com/content/15/8/e101432.full |
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