GIÁ TRỊ CHẨN ĐOÁN CỦA GIAO THỨC SIÊU ÂM NHANH TRONG SỐC (RUSH) TRONG PHÂN LOẠI CÁC THỂ SỐC CHƯA RÕ NGUYÊN NHÂN: MỘT NGHIÊN CỨU CẮT NGANG TẠI TRUNG TÂM CẤP CỨU A9, BỆNH VIỆN BẠCH MAI

Abstract

Objective: To evaluate the diagnostic accuracy of the Rapid Ultrasound in Shock (RUSH) protocol in classifying four types of shock (hypovolemic, cardiogenic, obstructive, and distributive) in patients with undifferentiated shock at the Emergency Department. Methods: We conducted a prospective cross-sectional study at the A9 Emergency Center, Bach Mai Hospital, from August 2024 to October 2025. Adult patients (≥18 years) presenting with shock (systolic blood pressure <90 mmHg or shock index >1) were enrolled. Bedside RUSH ultrasound was performed to categorize the type of shock. The RUSH-based classification was compared with the final confirmed diagnosis (“gold standard”) based on comprehensive clinical data, laboratory results, imaging, and treatment response after 24 hours. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and Cohen’s kappa (κ) were calculated. Results: Among 110 eligible patients, 100 were included in the final analysis (median age 66 [IQR 55–75], 60% male). Final diagnoses included distributive shock (58%), cardiogenic shock (22%), hypovolemic shock (13%), and obstructive shock (7%). The overall diagnostic accuracy of RUSH was 88.0%, with a Cohen’s kappa of 0.799 (p < 0.001), indicating good agreement. The RUSH protocol showed the highest diagnostic performance for cardiogenic shock (Se 90.9%; Sp 96.2%) and obstructive shock (Se 85.7%; Sp 98.9%). The negative predictive values for excluding these two types were 97.4% and 98.9%, respectively. Conclusion: The RUSH protocol is a rapid, feasible, and highly accurate bedside diagnostic tool, particularly reliable for identifying cardiogenic shock and ruling out obstructive shock. It provides timely guidance for the initial management of patients with undifferentiated shock in the emergency department.