{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T20:42:56Z","timestamp":1777322576309,"version":"3.51.4"},"reference-count":20,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T00:00:00Z","timestamp":1777161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Emergency Medical Service, Healthcare Center \u201cZOZ Legionowo\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Dyspnea is a common reason for emergency medical service (EMS) interventions and is associated with a substantial risk of severe clinical course, complications, and hospital admission. Its differential diagnosis in the prehospital setting remains challenging due to the limited availability of imaging modalities. Point-of-care ultrasound (POCUS), including lung ultrasound (LUS), is a rapid, field-applicable technique recommended in numerous acute respiratory diagnostic scenarios. Objective: To evaluate the use of lung ultrasound in the prehospital setting and its association with the precision of diagnoses related to respiratory failure, the frequency of transport to the emergency department (ED) among patients presenting with dyspnea\/respiratory failure, and to characterize the profile of sonographic findings with their correlation to clinical diagnostic categories. Additionally, transport rates in the study population were compared with aggregated regional data for the Masovian Voivodeship (excluding the analyzed county). Methods: A retrospective observational study was conducted on EMS interventions performed between 01 January 2025 and 30 June 2025 in Legionowo County (N = 353). The analysis included ICD-10 codes assigned in prehospital documentation (one primary code and up to two additional codes) in patients presenting with dyspnea and\/or respiratory failure, the performance of ultrasound examination, and resulting LUS findings (absence of pleural sliding and\/or lung point; B-lines; consolidations; C-lines; pleural effusion). Descriptive analyses, frequency comparison tests (\u03c72\/Fisher), estimation of relative risk (RR) with 95% confidence intervals (CI), and agreement analysis using Cohen\u2019s kappa coefficient (\u03ba) between etiological categories derived from ICD-10 codes and those inferred from LUS profiles were performed (\u03ba with 95% CI estimated using bootstrap resampling). The study was reported in accordance with the STROBE guidelines for observational studies. Additionally, the distribution of ICD-10 coding and the proportion of hospital transports across the entire Masovian Voivodeship were compared with those observed in the analyzed area. Results: Ultrasound examination was performed in 72\/353 (20.4%) EMS interventions; transport to the emergency department occurred in 239\/353 (67.7%) cases. The most frequent clinical categories based on ICD-10 codes were: general\/symptom-based 182\/353 (51.6%), inflammatory 77\/353 (21.8%), obstructive 66\/353 (18.7%), and cardiological 20\/353 (5.7%). Among abnormal LUS findings, the most common were B-lines (43\/72; 61.4%) and consolidations (29\/72; 41.4%). Consolidations were strongly associated with the inflammatory category (OR 9.72; p &lt; 0.001), whereas B-lines were associated with the cardiological category (OR 23.41; p = 0.0011) among cases in which LUS was performed. Ultrasound use was associated with a higher frequency of assigning at least one targeted (non-symptom-based) diagnosis within ICD coding: 53\/72 (73.6%) vs. 111\/278 (39.9%), RR 1.84 (95% CI 1.51\u20132.25; p &lt; 0.001). Agreement between the ICD-10 etiological category (inflammatory\/cardiological\/obstructive\/other) and the category inferred from the LUS profile was moderate: \u03ba = 0.36 (95% CI 0.21\u20130.51), with an observed agreement of 54.2%. Compared with aggregated regional data (Masovian Voivodeship excluding the analyzed county), the overall transport rate for comparable ICD-10 codes was lower in the study unit: 279\/409 (68.2%) vs. 11,351\/13,785 (82.3%), RR 0.83 (95% CI 0.78\u20130.89; p &lt; 0.001). The largest differences were observed for dyspnea (R06.0: 72.9% vs. 88.2%; RR 0.83) and obstructive codes (J44\/J45\/J46 combined: 43.1% vs. 67.0%; RR 0.64). Conclusions: In this retrospective analysis, an EMS unit with systematically implemented ultrasound demonstrated a lower frequency of hospital transport for selected dyspnea\/respiratory failure codes compared with regional data and greater precision in ICD-10 diagnostic coding in cases where ultrasound was performed. The profile of LUS findings correlated with clinical categories in a manner consistent with existing literature.<\/jats:p>","DOI":"10.3390\/diagnostics16091297","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"1297","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Prehospital Lung Ultrasound on Diagnostic Precision and Hospital Transport in Patients with Dyspnea and Respiratory Failure: A Retrospective Comparative Analysis"],"prefix":"10.3390","volume":"16","author":[{"given":"Damian","family":"Kowalczyk","sequence":"first","affiliation":[{"name":"Emergency Medical Service, Healthcare Center \u201cZOZ Legionowo\u201d, 4 General J\u00f3zef Sowi\u0144ski Street, 05-120 Legionowo, Poland"},{"name":"Department of Emergency Medical Service, Academy of Medical, Applied and Holistic Sciences, 02-304 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miko\u0142aj","family":"Tyczy\u0144ski","sequence":"additional","affiliation":[{"name":"Emergency Medical Service, Healthcare Center \u201cZOZ Legionowo\u201d, 4 General J\u00f3zef Sowi\u0144ski Street, 05-120 Legionowo, Poland"},{"name":"Department of Emergency Medical Service, Academy of Medical, Applied and Holistic Sciences, 02-304 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lindskou, T.A., Pilgaard, L., S\u00f8vs\u00f8, M.B., Kl\u00f8jg\u00e5rd, T.A., Larsen, T.M., Jensen, F.B., Weinrich, U.M., and Christensen, E.F. (2019). Symptom, Diagnosis and Mortality among Respiratory Emergency Medical Service Patients. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0213145"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1111\/acem.12380","article-title":"The Epidemiology and Outcome of Prehospital Respiratory Distress","volume":"21","author":"Prekker","year":"2014","journal-title":"Acad. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1007\/s11739-023-03322-8","article-title":"Acute Dyspnea in the Emergency Department: A Clinical Review","volume":"18","author":"Santus","year":"2023","journal-title":"Intern. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s00134-012-2513-4","article-title":"International Evidence-Based Recommendations for Point-of-Care Lung Ultrasound","volume":"38","author":"Volpicelli","year":"2012","journal-title":"Intensive Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2050312120932706","DOI":"10.1177\/2050312120932706","article-title":"Prehospital Point-of-Care Ultrasound: A Transformative Technology","volume":"8","author":"Amaral","year":"2020","journal-title":"SAGE Open Med."},{"key":"ref_6","first-page":"5271982","article-title":"Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults\u2014A Systematic Review and Meta-Analysis","volume":"2019","author":"Dahmarde","year":"2019","journal-title":"Can. Respir. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1590\/S1516-31802010000200009","article-title":"Diagnostic Accuracy of Sonography for Pleural Effusion: Systematic Review","volume":"128","author":"Grimberg","year":"2010","journal-title":"Sao Paulo Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e190703","DOI":"10.1001\/jamanetworkopen.2019.0703","article-title":"Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis","volume":"2","author":"Maw","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kowalczyk, D., Turkowiak, M., Piotrowski, W.J., Rosiak, O., and Bia\u0142as, A.J. (2023). Ultrasound on the Frontlines: Empowering Paramedics with Lung Ultrasound for Dyspnea Diagnosis in Adults\u2014A Pilot Study. Diagnostics, 13.","DOI":"10.3390\/diagnostics13223412"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/acem.14811","article-title":"Prehospital Lung Ultrasound in Acute Heart Failure: Impact on Diagnosis and Treatment","volume":"31","author":"Russell","year":"2024","journal-title":"Acad. Emerg. Med."},{"key":"ref_11","first-page":"227","article-title":"Explaining Odds Ratios","volume":"19","author":"Szumilas","year":"2010","journal-title":"J. Can. Acad. Child Adolesc. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"276","DOI":"10.11613\/BM.2012.031","article-title":"Interrater Reliability: The Kappa Statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Medica"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1378\/chest.07-2800","article-title":"Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure: The BLUE Protocol","volume":"134","author":"Lichtenstein","year":"2008","journal-title":"Chest"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1378\/chest.14-2608","article-title":"Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED: A SIMEU Multicenter Study","volume":"148","author":"Pivetta","year":"2015","journal-title":"Chest"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1017\/S1049023X22000711","article-title":"Use of Point-of-Care Ultrasound by Non-Physicians to Assess Respiratory Distress in the Out-of-Hospital Environment: A Scoping Review","volume":"37","author":"Donovan","year":"2022","journal-title":"Prehospital Disaster Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Nadim, G., Laursen, C.B., Pietersen, P.I., Wittrock, D., S\u00f8rensen, M.K., Nielsen, L.B., Rasmussen, C.-H., Christensen, H.M., Helmerik, S., and J\u00f8rgensen, G. (2021). Prehospital Emergency Medical Technicians Can Perform Ultrasonography and Blood Analysis in Prehospital Evaluation of Patients with Chronic Obstructive Pulmonary Disease: A Feasibility Study. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06305-7"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e5713","DOI":"10.1097\/MD.0000000000005713","article-title":"Lung Ultrasound for the Diagnosis of Pneumonia in Adults","volume":"96","author":"Long","year":"2017","journal-title":"Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Kowalczyk, D., Turkowiak, M., Piotrowski, W.J., Rosiak, O., and Bia\u0142as, A.J. (2024). Unlocking Diagnostic Precision: FATE Protocol Integration with BLUE and eFAST Protocols for Enhanced Pre-Hospital Differential Diagnosis of Pleural Effusion Manifested as Dyspnea in Adults-A Pilot Study. J. Clin. Med., 13.","DOI":"10.3390\/jcm13061573"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.15557\/JoU.2021.0036","article-title":"Signs and Lines in Lung Ultrasound","volume":"21","author":"Bhoil","year":"2021","journal-title":"J. Ultrason."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1297\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:51:16Z","timestamp":1777319476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,26]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091297"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091297","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,26]]}}}