Chest ultrasound in Italian geriatric wards: use, applications and clinicians’ attitudes

Andrea Ticinesi 1, Fulvio Lauretani 1, Antonio Nouvenne 1, Andrea Ungar 2, Raffaele Antonelli Incalzi 3, Simone Scarlata 3, On behalf of the GRETA (Gruppo di Ricerca sull’Ecografia Toracica nell’Anziano); Group of the Italian Society of Gerontology and Geriatrics (SIGG)

1 Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma and Department of Medicine and Surgery, University of Parma, Italy; 2 Geriatrics and Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Florence, Italy; 3 Unit of Geriatrics and Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio-Medico University and Teaching Hospital, Rome, Italy

Background and aims. Bedside chest ultrasound has emerged as a versatile and accurate diagnostic tool for the management of respiratory conditions in several clinical settings, integrating traditional imaging. The current utilization of this technique in geriatric hospital wards is still unknown. Our aim was to assess availability, uses and applications of chest ultrasonography in a convenience sample of 25 Italian geriatric wards.

Methods. A questionnaire, based on the current literature state-of-the-art, was e-mailed to head doctors of geriatric wards of Italian hospitals. The questionnaire explored ultrasound equipment availability, practice of chest ultrasound, expertise of ward physicians, clinical indications, and perceived impact on patient care. 

Results. Ultrasound equipment was available in 92% of wards, and chest ultrasound was performed in 82% of cases. Among the wards where chest ultrasound was performed, it was considered as routine assessment in only 52% of cases, mainly for diagnosis of pleural effusions (95%) and acute heart failure (89%), assessment of volemic state (79%), and assistance to invasive procedures (79%). It was used in emergency/urgency assessment of acute dyspnea in only 53% of cases. In most wards, only three or less physicians were able to perform chest ultrasound. In 53% of cases, head doctors declared that they perceived benefits of chest ultrasound in patient care in only selected cases. 

Conclusions. Chest ultrasound utilization in Italian geriatric wards is inhomogeneous, and the number of trained physicians is still limited. Geriatricians’ attitude towards chest ultrasound is generally cautious. Research and training programs are needed to spread the correct use of this technique in geriatric practice. 

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