Key result
Aortic VTI and maximum IVC diameter strongly discriminate distributive shock, peaking at AUC ~0.89.
Why the study?
Early recognition and appropriate treatment decrease morbidity and mortality in undifferentiated shock, but the best echocardiography and ultrasound parameters to differentiate shock types are unclear.
Do specific echocardiography and ultrasound parameters help differentiate shock types in patients with undifferentiated shock?
Cross-Sectional (n=140)
No
Do specific echocardiography and ultrasound parameters help differentiate shock types in patients with undifferentiated shock?
Effect estimate: AUC 0.8885 (95% CI 0.8144 to 0.9406)
p-value: p=<0.0001
Specific echocardiographic parameters, such as LVOT VTI and IVC maximum diameter, are effective discriminators for identifying the etiology of shock in the emergency setting.
Certain echo-US parameters differentiate shock etiology in ED; leaves open whether standardized protocols improve diagnostic accuracy or outcomes.
BACKGROUND: Early recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of cardiac tamponade, left ventricular function and right ventricular strain.Valvular assessment is absent in majority of ultasound protocols, while lung ultrasound is included in some of them. OBJECTIVE: In this study we investigated which parameters used in Echo - US protocol help differentiate shock types. METHODS: This cross sectional study was conducted on 150 patients with shock (140 patients were included while, 10 patients were excluded).Sensitivity and specificity of different parameters used in the Echo-US protocol were analyzed to detect which parameters can diffentiate shock types. RESULTS: Velocity time integral of Aorta and IVC maximum diameter were good discriminators for distributive shock, with area under the ROC curve (AUC) = 0.8885 (95% CI 0.8144 to 0.9406) and 0.7728 (95% CI 0.6832 to 0.8473) (Z = 10.256 p < 0.0001) and (Z = 5.079 p < 0.0001) respectively. Left ventricular systolic function, presence of pneumonia, pneumothorax or valve vegetations were of great value in differentiating shock types, while CUST, FAST, TAPSE and RV diameter were not useful in differentiating shock types. CONCLUSION: Ultrasound and echocardiography are powerful tools that can be used to identify shock etiology when the clinical picture overlaps.
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Ramadan et al. (2023) conducted a cross-sectional in Undifferentiated shock (n=140). Echocardiography and ultrasound protocol vs. Reference standard final clinical diagnosis was evaluated on Discrimination of distributive shock using Velocity Time Integral (VTI) of Aorta (AUC 0.8885, 95% CI 0.8144 to 0.9406, p=<0.0001). Velocity time integral of the aorta and inferior vena cava maximum diameter were strong discriminators for distributive shock, with AUCs of 0.8885 and 0.7728, respectively.
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