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The Potential Accuracy of the RUSH Exam

8 August 2018


Background: Shock is a life-threatening state of circulatory system failure. Undifferentiated shock must be discerned among hypovolemic, cardiogenic, obstructive, distributive, and mixed classifications to allow for swift management of the acute patient. The rapid ultrasound in shock (RUSH) exam is a proposed tool to differentiate shock and therefore expedite the management these patients.

Methods: An exhaustive literature search of available medical literature using the following databases: MEDLINE-PubMed, Medline-OVID, Clinical Key, and Web of Science. Articles were excluded if published in a non-English language. Studies included indications of accuracy, specifically sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and kappa. Articles were assessed for quality using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

Results: The search revealed 151 possible articles, 3 of which fit inclusion criteria for this review. Each article demonstrated a small population and either one or an unknown number of emergency department providers that performed the ultrasonography.

Conclusion: The RUSH exam appears to be a viable tool to be used by trained and experienced providers. More studies must be performed to verify wide or absent confidence interval findings from these 3 small population studies. Since there was no gold standard to compare, the studies relied on the end diagnosis of the patient, therefore error cannot be excluded from this standpoint.

Keywords: RUSH exam, rapid ultrasound in shock examination, ultrasound, shock, emergency, diagnostic, and accuracy


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