• Hugo De Carvalho, François Javaudin, Quentin Le Bastard, Anne-Sophie Boureau, Emmanuel Montassier, and Philippe Le Conte.
• Emergency Department.
• Eur J Emerg Med. 2021 Jan 1; 28 (1): 293329-33.

MethodsWe carried out a prospective study performed in our ED, included patients older than 75 years presenting with acute respiratory failure. Noninclusion criteria were documented palliative care or the need for immediate intensive care. After informed consent approval and routine diagnostic procedure (clinical, radiological and laboratory tests), the ED physician established the first diagnosis. Chest ultrasound was then performed, and a second diagnosis was established. An adjudication committee also established a diagnosis. The unweighted Cohen's kappa (κ) coefficient was used to measure the strength of agreement between routine diagnostic approach, chest ultrasound and adjudication committee diagnosis.ResultsA total of 89 patients were included, mean age 86 ± 5 years old. Concordance was very good (κ = 0.82) between chest ultrasound and adjudication committee diagnostic and moderate (κ = 0.52) between routine diagnostic approach and adjudication committee diagnostic. Cardiogenic pulmonary edema and community-acquired pneumonia were the most frequent diagnoses (48.5 and 27%, respectively). Chest ultrasound had higher sensitivity and specificity for both diagnoses.ConclusionIn our study, chest ultrasound add-on investigation to standard approach improved diagnosis performance in elderly patients presenting to the ED with acute respiratory failure. Further multicenter randomized trials are warranted to confirm this finding.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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