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Papers by Roberto Copetti

Research paper thumbnail of “Inverted Takotsubo” pattern

Research paper thumbnail of Immediate versus delayed integrated point-of-care-ultrasonography to manage acute dyspnea in the emergency department

Critical Ultrasound Journal, 2014

Background: Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ... more Background: Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ultrasound should help to differentiate cardiogenic from non-cardiogenic causes of dyspnea. We evaluated whether the diagnostic accuracy can be improved by adding a point-of-care-ultrasonography (POC-US) to routine exams and if an early use of this technique produces any advantage. Methods: One hundred sixty-eight patients were enrolled and randomized in two groups: Group 1 received an immediate POC-US in addition to routine laboratory and instrumental tests; group 2 received an ultrasound scan within 1 h from the admission to the Emergency Department. The concordance between initial and final diagnosis and the percentage of wrong diagnosis in the two groups were evaluated. Mortality, days of hospitalization in Emergency Medicine department and transfers to other wards were compared. Sensitivity and specificity of the routine protocol and the one including ultrasonography for the diagnosis of the causes of dyspnea were also analyzed. Results: Eighty-eight patients were randomized in group 1 and 80 in group 2. The concordance rate between initial and final diagnoses was significantly different (0.94 in group 1 vs. 0.22 in group 2, p < 0.005). The percentage of wrong initial diagnosis was 5% in group 1 and 50% in group 2 (p < 0.0001).

Research paper thumbnail of Traumatic epidural pneumorrhachis

Research paper thumbnail of Diffusion and practice of ultrasound in emergency medicine departments in Italy

Journal of Ultrasound, 2009

This paper reports data from a cognitive survey on the diffusion, practice and organization of ul... more This paper reports data from a cognitive survey on the diffusion, practice and organization of ultrasound (US) in emergency medicine departments (EMDs) in Italy. The study was carried out by the Emergency Medicine Section of the Italian Society for Ultrasound in Medicine and Biology (SIUMB) in collaboration with the Italian Society for Emergency Medicine and Urgent Care (SIMEU). We created a questionnaire with 10 items, relating to 4 thematic areas. The questionnaires were administered from September 2007 to February 2008, by email, telephone or regular mail. In August 2008 the data were subjected to nonparametric statistical analysis (Spearman&amp;amp;amp;amp;#39;s Rho and Pearson&amp;amp;amp;amp;#39;s chi-square - software SPSS). We analyzed 170 questionnaires from the EMDs of all Italian regions. A US scanner is present in 64.7% of the ERs, emergency US (E-US) is practiced only in 47.6% of the ERs, and only in 24% of these more than 60% of the ER team members have training in US. The diffusion of US in other operative units of the EMDs ranges from 8.2% to 26.5%. The presence of a US scanner in the ER is essential for the practice and training and is correlated with the level of the EMD. The use of US appears to be less common in less equipped hospitals, regardless of the size of the ER and the availability of radiological services. Wider diffusion of US and greater integration with other services for the installment of the required equipment is to be hoped for.

Research paper thumbnail of Clinical Integrated Ultrasound of the Thorax Including Causes of Shock in Nontraumatic Critically Ill Patients. A Practical Approach

Ultrasound in Medicine & Biology, 2012

A rapid identification of the causes of hemodynamic instability or cardiac arrest is crucial for ... more A rapid identification of the causes of hemodynamic instability or cardiac arrest is crucial for correct treatment. In a critical care setting, ultrasound seems to be an ideal tool for a rapid diagnosis. A multiple-goal problem-based approach represents the main peculiarity of emergency ultrasound and may be considered an extension of physical examination. The integration of data that can rapidly be obtained from the heart, lung, inferior vena cava, abdomen and leg vein examination are often essential for the diagnosis and treatment in critically ill patients. The role and potentiality of integrated ultrasound in cardiac arrest, shock/hypotension and severe dyspnea are considered in this article. (

Research paper thumbnail of Ultrasound Pattern in Pulmonary Fibrosis: Have the Vertical Artifacts Disappeared?

Ultrasound in Medicine & Biology, 2010

Research paper thumbnail of Ultrasound performs better than radiographs

Research paper thumbnail of Lung Ultrasound in Respiratory Distress Syndrome: A Useful Tool for Early Diagnosis

Neonatology, 2008

Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occur... more Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occurs almost exclusively in premature infants. At present, the diagnosis is based on radiological findings and clinical course. Lung ultrasound in RDS has not yet been fully assessed. The aim of the study was to define the ultrasonographic appearance of RDS and evaluate its clinical relevance. Lung sonography was performed in 40 newborn infants with radiological and clinical signs of RDS (mean gestational age 27.2 +/- 2.7 weeks, mean birth weight 1,057 +/- 361 g) and in 15 preterm infants without RDS (mean gestational age 30.4 +/- 3.4 weeks, mean birth weight 1,775 +/- 669 g). In all the studied infants with RDS, lung ultrasound consistently showed generalized alveolar-interstitial syndrome (echographic &amp;amp;amp;amp;amp;amp;#39;white lung&amp;amp;amp;amp;amp;amp;#39;), pleural line abnormalities (small subpleural consolidations, thickening, irregularity and coarse appearance) and an absence of areas with a normal pattern (&amp;amp;amp;amp;amp;amp;#39;spared areas&amp;amp;amp;amp;amp;amp;#39;). When presented simultaneously, these signs identify RDS with a sensitivity and specificity of 100%. We found that lung ultrasound is a reliable tool in the diagnosis of RDS. We speculate that it may be considered as a screening method for the diagnosis of RDS, and for early administration of surfactant in preterm infants with respiratory distress.

Research paper thumbnail of Life-Threatening Proarrhythmia in a Patient with Orthodromic Atrioventricular Tachycardia Treated with Low-Dose Adenosine

Journal of Cardiovascular Electrophysiology, 2005

Research paper thumbnail of Early repolarization in arrhythmogenic left ventricular cardiomyopathy: insights from cardiac magnetic resonance imaging

International Journal of Cardiology, 2012

G. Nucifora). Fig. 1. Twelve-lead ECG showing an extremely fast broad-complex tachycardia, consis... more G. Nucifora). Fig. 1. Twelve-lead ECG showing an extremely fast broad-complex tachycardia, consistent with ventricular flutter.

Research paper thumbnail of International evidence-based recommendations on ultrasound-guided vascular access

Intensive Care Medicine, 2012

Writing committee: G Volpicelli (Emergency Medicine,

Research paper thumbnail of Optic nerve ultrasound: artifacts and real images

Intensive Care Medicine, 2009

Research paper thumbnail of Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

Cardiovascular Ultrasound, 2008

Background: Differential diagnosis between acute cardiogenic pulmonary edema (APE) and acute lung... more Background: Differential diagnosis between acute cardiogenic pulmonary edema (APE) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS) may often be difficult. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE.

Research paper thumbnail of Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED

The American Journal of Emergency Medicine, 2009

Objectives: The aim of this study is to assess the ability of bedside lung ultrasound (US) to con... more Objectives: The aim of this study is to assess the ability of bedside lung ultrasound (US) to confirm clinical suspicion of pneumonia and the feasibility of its integration in common emergency department (ED) clinical practice. Methods: In this study we performed lung US in adult patients admitted in our ED with a suspected pneumonia.Subsequently, a chest radiograph (CXR) was carried out for each patient. A thoracic computed tomographic (CT) scan was made in patients with a positive lung US and a negative CXR. In patients with confirmed pneumonia, we performed a follow-up after 10 days to evaluate clinical conditions after antibiotic therapy. Results: We studied 49 patients: pneumonia was confirmed in 32 cases (65.3%). In this group we had 31 (96.9%) positive lung US and 24 (75%) positive CXR. In 8 (25%) cases, lung US was positive with a negative CXR. In this group, CT scan always confirmed the US results. In one case, US was negative and CXR positive. Follow-up turned out to be always consistent with the diagnosis. Conclusion: Considering that lung US is a bedside, reliable, rapid, and noninvasive technique, these results suggest it could have a significant role in the diagnostic workup of pneumonia in the ED, even if no sensitivity nor specificity can be inferred from this study because the real gold standard is CT, which could not be performed in all patients.

Research paper thumbnail of Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Critical Care, 2012

The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile inf... more The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.

Research paper thumbnail of “Inverted Takotsubo” pattern

Research paper thumbnail of Immediate versus delayed integrated point-of-care-ultrasonography to manage acute dyspnea in the emergency department

Critical Ultrasound Journal, 2014

Background: Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ... more Background: Dyspnea is one of the most frequent complaints in the Emergency Department. Thoracic ultrasound should help to differentiate cardiogenic from non-cardiogenic causes of dyspnea. We evaluated whether the diagnostic accuracy can be improved by adding a point-of-care-ultrasonography (POC-US) to routine exams and if an early use of this technique produces any advantage. Methods: One hundred sixty-eight patients were enrolled and randomized in two groups: Group 1 received an immediate POC-US in addition to routine laboratory and instrumental tests; group 2 received an ultrasound scan within 1 h from the admission to the Emergency Department. The concordance between initial and final diagnosis and the percentage of wrong diagnosis in the two groups were evaluated. Mortality, days of hospitalization in Emergency Medicine department and transfers to other wards were compared. Sensitivity and specificity of the routine protocol and the one including ultrasonography for the diagnosis of the causes of dyspnea were also analyzed. Results: Eighty-eight patients were randomized in group 1 and 80 in group 2. The concordance rate between initial and final diagnoses was significantly different (0.94 in group 1 vs. 0.22 in group 2, p < 0.005). The percentage of wrong initial diagnosis was 5% in group 1 and 50% in group 2 (p < 0.0001).

Research paper thumbnail of Traumatic epidural pneumorrhachis

Research paper thumbnail of Diffusion and practice of ultrasound in emergency medicine departments in Italy

Journal of Ultrasound, 2009

This paper reports data from a cognitive survey on the diffusion, practice and organization of ul... more This paper reports data from a cognitive survey on the diffusion, practice and organization of ultrasound (US) in emergency medicine departments (EMDs) in Italy. The study was carried out by the Emergency Medicine Section of the Italian Society for Ultrasound in Medicine and Biology (SIUMB) in collaboration with the Italian Society for Emergency Medicine and Urgent Care (SIMEU). We created a questionnaire with 10 items, relating to 4 thematic areas. The questionnaires were administered from September 2007 to February 2008, by email, telephone or regular mail. In August 2008 the data were subjected to nonparametric statistical analysis (Spearman&amp;amp;amp;amp;#39;s Rho and Pearson&amp;amp;amp;amp;#39;s chi-square - software SPSS). We analyzed 170 questionnaires from the EMDs of all Italian regions. A US scanner is present in 64.7% of the ERs, emergency US (E-US) is practiced only in 47.6% of the ERs, and only in 24% of these more than 60% of the ER team members have training in US. The diffusion of US in other operative units of the EMDs ranges from 8.2% to 26.5%. The presence of a US scanner in the ER is essential for the practice and training and is correlated with the level of the EMD. The use of US appears to be less common in less equipped hospitals, regardless of the size of the ER and the availability of radiological services. Wider diffusion of US and greater integration with other services for the installment of the required equipment is to be hoped for.

Research paper thumbnail of Clinical Integrated Ultrasound of the Thorax Including Causes of Shock in Nontraumatic Critically Ill Patients. A Practical Approach

Ultrasound in Medicine & Biology, 2012

A rapid identification of the causes of hemodynamic instability or cardiac arrest is crucial for ... more A rapid identification of the causes of hemodynamic instability or cardiac arrest is crucial for correct treatment. In a critical care setting, ultrasound seems to be an ideal tool for a rapid diagnosis. A multiple-goal problem-based approach represents the main peculiarity of emergency ultrasound and may be considered an extension of physical examination. The integration of data that can rapidly be obtained from the heart, lung, inferior vena cava, abdomen and leg vein examination are often essential for the diagnosis and treatment in critically ill patients. The role and potentiality of integrated ultrasound in cardiac arrest, shock/hypotension and severe dyspnea are considered in this article. (

Research paper thumbnail of Ultrasound Pattern in Pulmonary Fibrosis: Have the Vertical Artifacts Disappeared?

Ultrasound in Medicine & Biology, 2010

Research paper thumbnail of Ultrasound performs better than radiographs

Research paper thumbnail of Lung Ultrasound in Respiratory Distress Syndrome: A Useful Tool for Early Diagnosis

Neonatology, 2008

Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occur... more Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occurs almost exclusively in premature infants. At present, the diagnosis is based on radiological findings and clinical course. Lung ultrasound in RDS has not yet been fully assessed. The aim of the study was to define the ultrasonographic appearance of RDS and evaluate its clinical relevance. Lung sonography was performed in 40 newborn infants with radiological and clinical signs of RDS (mean gestational age 27.2 +/- 2.7 weeks, mean birth weight 1,057 +/- 361 g) and in 15 preterm infants without RDS (mean gestational age 30.4 +/- 3.4 weeks, mean birth weight 1,775 +/- 669 g). In all the studied infants with RDS, lung ultrasound consistently showed generalized alveolar-interstitial syndrome (echographic &amp;amp;amp;amp;amp;amp;#39;white lung&amp;amp;amp;amp;amp;amp;#39;), pleural line abnormalities (small subpleural consolidations, thickening, irregularity and coarse appearance) and an absence of areas with a normal pattern (&amp;amp;amp;amp;amp;amp;#39;spared areas&amp;amp;amp;amp;amp;amp;#39;). When presented simultaneously, these signs identify RDS with a sensitivity and specificity of 100%. We found that lung ultrasound is a reliable tool in the diagnosis of RDS. We speculate that it may be considered as a screening method for the diagnosis of RDS, and for early administration of surfactant in preterm infants with respiratory distress.

Research paper thumbnail of Life-Threatening Proarrhythmia in a Patient with Orthodromic Atrioventricular Tachycardia Treated with Low-Dose Adenosine

Journal of Cardiovascular Electrophysiology, 2005

Research paper thumbnail of Early repolarization in arrhythmogenic left ventricular cardiomyopathy: insights from cardiac magnetic resonance imaging

International Journal of Cardiology, 2012

G. Nucifora). Fig. 1. Twelve-lead ECG showing an extremely fast broad-complex tachycardia, consis... more G. Nucifora). Fig. 1. Twelve-lead ECG showing an extremely fast broad-complex tachycardia, consistent with ventricular flutter.

Research paper thumbnail of International evidence-based recommendations on ultrasound-guided vascular access

Intensive Care Medicine, 2012

Writing committee: G Volpicelli (Emergency Medicine,

Research paper thumbnail of Optic nerve ultrasound: artifacts and real images

Intensive Care Medicine, 2009

Research paper thumbnail of Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome

Cardiovascular Ultrasound, 2008

Background: Differential diagnosis between acute cardiogenic pulmonary edema (APE) and acute lung... more Background: Differential diagnosis between acute cardiogenic pulmonary edema (APE) and acute lung injury/acute respiratory distress syndrome (ALI/ARDS) may often be difficult. We evaluated the ability of chest sonography in the identification of characteristic pleuropulmonary signs useful in the diagnosis of ALI/ARDS and APE.

Research paper thumbnail of Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED

The American Journal of Emergency Medicine, 2009

Objectives: The aim of this study is to assess the ability of bedside lung ultrasound (US) to con... more Objectives: The aim of this study is to assess the ability of bedside lung ultrasound (US) to confirm clinical suspicion of pneumonia and the feasibility of its integration in common emergency department (ED) clinical practice. Methods: In this study we performed lung US in adult patients admitted in our ED with a suspected pneumonia.Subsequently, a chest radiograph (CXR) was carried out for each patient. A thoracic computed tomographic (CT) scan was made in patients with a positive lung US and a negative CXR. In patients with confirmed pneumonia, we performed a follow-up after 10 days to evaluate clinical conditions after antibiotic therapy. Results: We studied 49 patients: pneumonia was confirmed in 32 cases (65.3%). In this group we had 31 (96.9%) positive lung US and 24 (75%) positive CXR. In 8 (25%) cases, lung US was positive with a negative CXR. In this group, CT scan always confirmed the US results. In one case, US was negative and CXR positive. Follow-up turned out to be always consistent with the diagnosis. Conclusion: Considering that lung US is a bedside, reliable, rapid, and noninvasive technique, these results suggest it could have a significant role in the diagnostic workup of pneumonia in the ED, even if no sensitivity nor specificity can be inferred from this study because the real gold standard is CT, which could not be performed in all patients.

Research paper thumbnail of Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound

Critical Care, 2012

The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile inf... more The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.