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Investigation of Focused Cardiac Ultrasound in the Emergency Room for Differentiation of Cardiac and Non-Cardiac Causes of Respiratory Distress in Dogs

Research output: Contribution to journalArticle

Original languageEnglish
JournalJournal of Veterinary Emergency and Critical Care
DateAccepted/In press - 3 Jun 2018

Abstract

Objective: To determine whether focused cardiac ultrasound (FOCUS) performed by emergency and critical care (ECC) specialists or residents in training improves differentiation of cardiac (C) vs. non-cardiac (NC) causes of respiratory distress in dogs compared to medical history and physical examination (PE) alone.

Design: Prospective cohort study (May 2014 - February 2016). Setting: University hospital.

Animals: Thirty-eight dogs presenting with respiratory distress. Interventions: FOCUS.

Measurements and Main Results: Medical history, physical examinationPE, and FOCUS were obtained at presentation. ECC clinicians, blinded to any radiographic or echocardiographic data, categorized each patient (C vs. NC) before and after FOCUS. Thoracic radiography (within 3 hours) and echocardiography (within 24 hours) were performed. Percent agreement was calculated against a reference diagnosis that relied on agreement of a board-certified cardiologist and ECC clinician with access to all diagnostic test results. Reference diagnosis included 22 dogs with cardiac and 13 dogs with non-cardiac causes of respiratory distress. In 3 dogs a reference diagnosis was not established. Prior to FOCUS, positive and negative percent agreement to detect cardiac causes was 90.9% (95% CI, 70.8-98.9%) and 53.9% (25.1-80.8%), respectively. Overall agreement occurred in 27/35 dogs (77.1%). Two C and 6 NC cases were incorrectly categorized. Following FOCUS, positive and negative percent agreement to detect cardiac causes was 95.5% (77.2-99.9%) and 69.2% (38.6-90.9%), respectively. Overall agreement occurred in 30/35 dogs (85.7%). Three dogs with discrepant pre-FOCUS diagnoses were correctly re-categorized post-FOCUS. One C and 4 NC cases remained incorrectly categorized. No correctly categorized dogs were incorrectly re-categorized following FOCUS. The proportions of dogs correctly classified pre- vs. post-FOCUS were not significantly different (P=0.25).

Conclusions: Overall agreement of ECC clinicians in determining C vs. NC causes of respiratory distress in dogs based on medical history and PE was relatively high, and FOCUS did not significantly improve overall agreement.FOCUS did not significantly improve differentiation of C vs NC causes of respiratory distress compared to medical history and physical examination alone.

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