Since the onset of the COVID-19 pandemic, the practice of “boarding” patients admitted to the hospital in the
Emergency Department (ED) has reached unprecedented levels. For critically ill patients including those with
acute decompensated heart failure (ADHF), ED boarding worsens outcomes as patients spend hours in the ED
waiting to be transferred to the appropriate inpatient ward for specialized care. Given the unabated increase in
ED boarding, length of ED stay, and subsequent time to specialist evaluation and management, developing new
technologies to enable rapid reassessment of ADHF patients during these protracted ED stays is critical for
improved care and patient outcomes. In a typical workflow in the Emergency Department, physicians perform
bedside lung ultrasound once, at time of initial patient presentation, and use the presence or absence of ‘B-
Lines’ in the images as a biomarker for pulmonary congestion. Often assessed by ED physicians in a binary
manner, the presence of B-lines is used in conjunction with a clinical exam and blood tests to rule in acute ADHF.
While detecting B-lines can be as easy as looking at two lung zones to make a clinical decision of ADHF, counting
B-lines requires both skill and training in B-line identification, and in aggregating B-line counts over 8+ lung
zones for accuracy. For a busy ED physician this is prohibitive given constraints on time, training, and cognitive
load. To ease this problem, ED physicians need tools that can automatically count and aggregate the B-lines to
quantify the severity of the congestion. Without this automation, it is entirely possible that either suboptimal or
even no treatment will be initiated for ADHF patients in the ED leading to increased hospital length of stay, further
perpetuating the ED boarding. The creation of tools for automatic quantification has the potential to enable
workflows with reassessment to meet the changing patient care needs. Our long-term goals are to develop
computational tools that mitigate the operator-dependence endemic to ultrasound image acquisition and
interpretation. The objective of this Trailblazer R21 application is to develop and validate computational methods
for quantifying pulmonary congestion from bedside lung ultrasound in the ED, which will be achieved by (1)
developing and evaluating explainable tools for automated quantification of pulmonary congestion using
retrospective lung ultrasound data and (2) validating the performance of the trained models in a workflow
demonstrated by a prospective observational study in which patients presenting to the ED with ADHF will be
assessed with lung ultrasound both pre-and post-therapeutic intervention, and findings typically used to measure
pulmonary congestion on inpatient services will be recorded for both time points.
