In this episode of Journal Jam 12 BNP for Diagnosis of Acute CHF [Link is to the podcast and show notes] from the always fantastic Emergency Medicine Cases, the experts address the usefulness of BNP.
The EMC experts bottom line conclusion is that BNP is not helpful especially now that we have Point Of Care Ultrasound.
The summary of the whole podcast begins at 42:00. But if you can listen to the whole podcast.
I’d say that this is the best EM Cases podcast ever but I’d say it after every one of them that I review. Listen, learn, and enjoy. And be sure to enjoy the Evidence Based Medicine nugget in the podcast on Spectrum Bias*.
*See also The spectrum effect in tests for risk prediction, screening, and diagnosis. [PubMed Citation] [Full Text HTML] [Full Text PDF]. BMJ. 2016 Jun 22;353:i3139. doi: 10.1136/bmj.i3139.
What follows are extracts from the show notes:
ED physicians are only about 80% accurate in their diagnosis of acute CHF. Why? There is no single element of past medical history, presenting symptoms or physical exam findings that can reliably rule in or rule out acute CHF in the ED. Orthopnea, PND and weight gain are not especially helpful in making the diagnosis and even the lauded S3 gallop which most of us cannot identify on the best of ED shifts is not that helpful. The classic signs of CHF are often absent on CXR and interobserver agreement (whether you are an ED doc or a radiologist) on the diagnosis of CHF by CXR is enormous. Nonetheless, when all of these elements are put together, ED physician clinical gestalt is not bad at diagnosing CHF. But we could do better.
Enter BNP. BNP is currently in use in many EDs across North America and Europe. In this Journal Jam podcast we discuss the clinical utility of BNP and pro-NT-BNP in the work-up of the dyspneic ED patient. We ask the questions: does BNP add much beyond physician gestalt? Which patients might BNP be useful for? Should we abandon BNP as a dichotomous rule-in/rule-out variable and instead use it as a continuous variable? Does using BNP effect patient oriented outcomes? Is lung POCUS a better test? Are prediction models that include BNP useful? and many more….
