Early diagnosis and appropriate management of shock aimed at prevention of prolonged hypoperfusion has shown to decrease morbidity and mortality in patients with undifferentiated shock. However, there is often a challenge in emergency department (ED) – where diagnosis is mainly based on clinical signs and standard monitoring parameters. Early use of point of care ultrasound could reduce the diagnostic time and improve diagnostic accuracy. The aim of this study is to investigate the accuracy of echocardiography - ultrasound protocol to identify the cause of shock in ED. The study was conducted on 150 shocked patients admitted to emergency department of Alexandria Main University Hospital from December 2018 to December 2020. The study was conducted to reach initial impression about shock etiology which was then compared to final diagnosis to determine accuracy, agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). One hundred forty patients were included in the study (10 patients were excluded). The protocol was 100% accurate for diagnosing cases with obstructive and mixed obstructive distributive shock. It showed excellent rule- out characteristics for cardiogenic shock (sensitivity and NPV = 100%). There was almost perfect agreement between provisional and final shock type for mixed distributive cardiogenic shock (kappa 0.915). Echo- US protocol had lowest agreement and PPV for patients with hypovolemic shock Kappa 0.48 and 35% respectively. The Echo- US protocol showed a high accuracy in identifying shock etiology in ED and is likely a promising diagnostic tool in emergency care.

中文翻译：

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超声心动图和超声方案识别急诊科休克病因的准确性

旨在预防长期低灌注的休克的早期诊断和适当管理已显示可降低未分化休克患者的发病率和死亡率。然而，急诊科 (ED) 经常面临挑战——诊断主要基于临床体征和标准监测参数。早期使用床旁超声可以减少诊断时间并提高诊断准确性。本研究的目的是调查超声心动图的准确性 - 超声方案以确定 ED 中休克的原因。该研究是对 2018 年 12 月至 2020 年 12 月在亚历山大主要大学医院急诊科收治的 150 名震惊患者进行的。进行该研究以获得关于休克病因的初步印象，然后将其与最终诊断进行比较以确定准确性、一致性、敏感性、特异性、阳性预测值 (PPV) 和阴性预测值 (NPV)。140 名患者被纳入研究（10 名患者被排除）。该方案对于诊断阻塞性和混合性阻塞性分布性休克病例是 100% 准确的。它显示出极好的心源性休克排除特征（敏感性和 NPV = 100%）。混合分布性心源性休克的临时和最终休克类型几乎完全一致（kappa 0.915）。Echo-US 方案对低血容量性休克患者的一致性和 PPV 最低，Kappa 分别为 0.48 和 35%。