Study: Use this test for shortness of breath
Study: Use this test for shortness of breath
Shortness of breath is a common complaint in the ED, but often is misdiagnosed, according to a new study of 592 patients.1 For 185 patients, there was clinical indecision as to the correct diagnosis, and 103 of this group had acutely destabilized heart failure.
"When indecision is present, the effects extend well beyond the boundaries of the ED," says James Louis Januzzi, MD, one of the study's authors and associate director of the coronary care unit at Massachusetts General Hospital in Boston. "These patients tend to have longer hospital lengths of stay, more random diagnostic testing, and tend to do worse than patients in whom diagnostic uncertainty is not present."
Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) testing may help to determine if patients have heart failure, says Januzzi. "More routine NT-proBNP or BNP testing at the time of the first ED contact for dyspnea evaluation will reduce missed diagnoses, improve triage, and ultimately save lives," says Januzzi. Consider the following:
A very high NT-proBNP result, more often than not, indicates heart failure. However, this may also indicate pulmonary emboli, acute coronary ischemia, and various nonheart failure types of heart disease, including atrial fibrillation or aortic stenosis, says Januzzi.
A very low value of BNP or NT-proBNP generally excludes heart failure. However, the situations where that can be falsely low include mild heart failure, diastolic heart failure, or right heart failure, as well in very obese patients.
"If you are working in triage and shortness of breath is a complaint, an NT-proBNP or BNP is a valuable adjunct to evaluation, unless the patient is clearly asthmatic, or some other easily recognized diagnosis," says Januzzi. "And the sooner it is ordered, the better."
Reference
- Green SM, Martinez-Rumayor A, Gregory SA, et al. Clinical uncertainty, diagnostic accuracy, and outcomes in emergency department patients presenting with dyspnea. Arch Intern Med 2008; 168:741-748.
Source
For more information on amino-terminal pro-B-type natriuretic peptide testing in the ED, contact:
- James Louis Januzzi, MD, Associate Director, Coronary Care Unit, Massachusetts General Hospital, Boston. Phone: (617) 726-3443. E-mail: [email protected].
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