Koops, R. (Rense) (2017) Aanvullende waarde van spoedechografie ter inschatting van de volumestatus bij patiënten met hyponatriëmie op de SEH. thesis, Medicine.
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Abstract
Introduction: Reliable evaluation of the volume status is essential in the therapeutic approach of patients with hyponatraemia and appears to be difficult. Misdiagnosis can have life-threatening consequences, although there is no adequate diagnostic method available. This pilot study investigates the added-value of IVC emergency ultrasound evaluation of the volume status in the diagnostic process of hyponatraemia in the emergency department. Methods: All non-trauma patients admitted to the emergency department during a 18 week period were screened on a serum sodium level of < 135 mmol/L. Using IVC ultrasound, the caval index (CI) was measured, during normal and deep inspiration and using B-mode and M-mode. A CI of >36,5% was associated with hypovolemia and a CI of < 36,5% with eu- or hypervolemia, which was evaluated by an independent expert. Further, the change in certainty of the clinical evaluation by the attending doctor was determined using a 5-point numeric rating scale (NRS). Results: A total number of 25 patients was included out of a selection of 807 screened patients. Sensitivity and specificity analysis of emergency ultrasound as a diagnostic test for hypovolemia compared to the expert, showed a sensitivity of 64% and a specificity of 82% (PPV 82%, NPV 64%). The clinical evaluation of the attending doctor showed a sensitivity of 78% and a specificity of 54% (PPV 65%, NPV 63%). A CI-cut-off value of 50% increases the specificity (91% vs. 82%) and PPV (89% vs. 82%). ROC-analysis of the CI compared to the expert showed a AUC of 0,766 (± 0,096, 95% CI 0,579-0,954), with an optimal cut-off value of 34,1% (sens. 71,4%, spec. 72,7%). Affirmative ultrasound evaluation increases the doctor’s certainty accurately. B-mode during normal inspiration is the ultrasound technique of preference. Conclusions: Emergency ultrasound of the IVC to evaluate the volume status has added-value in the diagnostic approach of patients with hyponatraemia in the emergency department, combined with the clinical evaluation of the attending doctor. The doctor is able to screen for hypovolemia, the ultrasound is able to confirm hypovolemia subsequently (specificity 91%, PPV 89%), using a CI cut-off value of 50% and B-mode during normal inspiration. In addition, emergency ultrasound increases the doctor’s certainty accurately in the case of an affirmative ultrasound evaluation.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Afdeling Spoedeisende hulp UMCG Begeleiders: and Maaten, Prof. dr. J.C. ter and en and Olgers, T.J. and internisten |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1245 |
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