Authors' Reply: Can Bedside Focused Ultrasonography Cause Confusion in Patient Diagnosis?

Abstract

Dear Editor,

First of all, we would like to thank the esteemed readers for their interest in our article titled “Diagnostic Evaluation of Patients Presenting with Dyspnea to the Emergency Department Using Bedside Focused Ultrasonography” and for their valuable scientific contributions [1,2]. Their kind comments are greatly appreciated, and we are pleased to address their questions as follows:

1. Ultrasound Operator:
As stated in the “Data Collection” section of the Materials and Methods, all ultrasonographic assessments were performed by a senior emergency medicine resident who had completed Basic and Advanced Ultrasonography and Emergency Critical Care training (1). The investigator aimed to reach a diagnosis based solely on BFUS findings.

2. Potential Confounding Diagnoses:
Due to the real-world, fast-paced nature of emergency department decision-making, BFUS was used to reach a preliminary diagnosis. Therefore, coexisting conditions such as chronic thromboembolism or heart failure with preserved ejection fraction (HFpEF) may not have been fully identified in all patients through advanced diagnostics. However, final diagnoses were obtained based on hospital records and inpatient follow-up data, and were detailed as much as possible. The primary goal of the study was to evaluate the diagnostic accuracy of BFUS during the initial assessment.

3. NT-proBNP and Diastolic Dysfunction Evaluation:
In this study, NT-proBNP measurement was not performed in all patients, as the diagnosis made by the first attending physician was accepted as the gold standard due to the retrospective design of the study. The investigator performed bedside focused ultrasonography (BFUS) blinded to the patients’ physical examination findings and laboratory results. However, the patients’ medical records were reviewed retrospectively; the imaging studies and laboratory tests performed were examined, and the consultation notes were analyzed. In this way, the validity of the diagnoses accepted as the gold standard was further strengthened. This point was also addressed in the data collection section of the Materials and Methods part [1].

4. Pulmonary Embolism and Hemodynamic Stability:
As shown in the patient flowchart (Figure 2), hemodynamically unstable patients were excluded from the study [1]. According to current BFUS guidelines, it is not feasible to distinguish between acute and chronic pulmonary embolism using this method [3,4]. As the readers correctly pointed out, right heart strain findings are not specific for pulmonary embolism; this limitation was addressed in the discussion section of the article.

5. Right Ventricular Dilatation and IVC Diameter:
In Table 3, while 27 patients had an IVC diameter >2.1 cm, right ventricular dilatation was observed in only 9 cases [1]. This discrepancy highlights the need for careful interpretation. It was acknowledged in our study that this variation reflects one of the practical limitations of BFUS use in the emergency department. As emphasized in the discussion, BFUS is intended as a rapid and targeted diagnostic tool and differs from advanced cardiologic ultrasonographic assessments.

In conclusion, we sincerely thank the authors once again for their thoughtful feedback. We believe such scientific exchanges are vital for advancing emergency ultrasound research and improving its clinical application.

Sincerely,