{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:40:11Z","timestamp":1773312011978,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,11,9]],"date-time":"2017-11-09T00:00:00Z","timestamp":1510185600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"University of Michigan Global Reach Programme"},{"name":"University of Michigan International Institute"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess the effects of a cardiopulmonary ultrasound (<jats:styled-content style=\"fixed-case\">CPUS<\/jats:styled-content>) examination on diagnostic accuracy for critically ill patients in a resource\u2010limited setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (<jats:styled-content style=\"fixed-case\">KATH<\/jats:styled-content>) in Kumasi, Ghana, were trained in a <jats:styled-content style=\"fixed-case\">CPUS<\/jats:styled-content> protocol. Adult patients triaged to the resuscitation area of the emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) were enrolled if they exhibited signs or symptoms of shock or respiratory distress. Patients were assigned to the intervention group if their treating physician had completed the <jats:styled-content style=\"fixed-case\">CPUS<\/jats:styled-content> training. The physician's initial diagnostic impression was recorded immediately after the history and physical examination in the control group, and after an added <jats:styled-content style=\"fixed-case\">CPUS<\/jats:styled-content> examination in the intervention group. This was compared to a standardised final diagnosis derived from post hoc chart review of the patient's care at 24 h by two blinded, independent reviewers using a clearly defined and systematic process. Secondary outcomes were 24\u2010h mortality and use of <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> fluids, diuretics, vasopressors and bronchodilators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 890 patients presenting during the study period, 502 were assessed for eligibility, and 180 patients were enrolled. Diagnostic accuracy was higher for patients who received the <jats:styled-content style=\"fixed-case\">CPUS<\/jats:styled-content> examination (71.9% <jats:italic>vs<\/jats:italic>. 57.1%, \u0394 14.8% [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.5%, 28.4%]). This effect was particularly pronounced for patients with a \u2018cardiac\u2019 diagnosis, such as cardiogenic shock, congestive heart failure or acute valvular disease (94.7% <jats:italic>vs<\/jats:italic>. 40.0%, \u0394 54.7% [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 8.9%, 86.4%]). Secondary outcomes were not different between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In an urban <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> in Ghana, a <jats:styled-content style=\"fixed-case\">CPUS<\/jats:styled-content> examination improved the accuracy of the treating physician's initial diagnostic impression. There were no differences in 24\u2010h mortality and a number of patient care interventions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12992","type":"journal-article","created":{"date-parts":[[2017,10,26]],"date-time":"2017-10-26T16:52:52Z","timestamp":1509036772000},"page":"1599-1608","source":"Crossref","is-referenced-by-count":28,"title":["Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resource\u2010limited setting: the <scp>AFRICA<\/scp> trial"],"prefix":"10.1111","volume":"22","author":[{"given":"Torben K.","family":"Becker","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Florida Gainesville FL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea A.","family":"Tafoya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Highland Hospital Oakland CA 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