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Case Series: Point-of-Care Ultrasound on Oncology Inpatients with Respiratory Abnormalities

Jodi Ezratty, Waleed Kian, Nadav Wallach, Re’em Sadeh, Aharon Y. Cohen, Dina Levitas, Yuval Mizrakli, Wafeek Alguayn, Laila C. Roisman, Alexander Yakobson and Lior Fuchs

Background: Here, we present for the first time a case series demonstrating the ability of Point of Care ultrasonography (POCUS) to contribute clinically significant findings, which may affect the management of oncologic inpatients with respiratory symptoms.

Methods: We present a pilot, prospective case series of 13 patients with various malignancies admitted to the inpatient oncology ward at a large tertiary medical center. Patients presenting dyspnea or other respiratory abnormalities were examined by POCUS of the heart, lungs, and IVC. Exam findings were delivered to the patients’ treating physicians with no other treatment or management recommendations. Our primary outcome was to assess the association between POCUS findings and the rate of management change among oncology patients with respiratory symptoms (i.e., administration of a new medication, new consult, new procedure, or transfer of a patient to another ward).

Results: Thirteen cancer patients admitted to the oncology ward who presented with dyspnea or developed a respiratory abnormality during their hospital stay were enrolled in the study. All received POCUS assessment for dyspnea. The POCUS exam revealed clinically relevant findings and led to alteration management among 11/13 (84%) of patients. Among 6/11 (54.5%) patients, a new procedure was performed (four pleural taps, one pleural drain was removed, one dialysis), in 3/11 patients (27.2%) a new imaging study was ordered (echocardiography in all cases), in 2/11 patients (18.1%) a new consult was requested, and in 3/11 patients (27.2%) a change in medical management was made based on POCUS findings.

Conclusion: This case series shows that the incorporation of POCUS exam into routine diagnostic workup of patients admitted to the oncological ward with new respiratory abnormalities does lead to frequent change in patient management and may potentially improve patient outcomes. The potential information provided from this study may be instrumental in the initial workup and working diagnosis of a patient presenting with acute symptoms.