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Observational Study
. 2020 May 29;28(1):47.
doi: 10.1186/s13049-020-00740-x.

Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Jesper Weile  1   2 , Christian A Frederiksen  3 , Christian B Laursen  4 , Ole Graumann  5   6 , Erik Sloth  7 , Hans Kirkegaard  8   9
Affiliations
Observational Study

Point-of-care ultrasound induced changes in management of unselected patients in the emergency department - a prospective single-blinded observational trial

Jesper Weile et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Point-of-Care ultrasound (POCUS) changes the management in specific groups of patients in the Emergency Department (ED). It seems intuitive that POCUS holds an unexploited potential on a wide variety of patients. However, little is known about the effect of ultrasound on the broad spectrum of unselected patients in the ED. This study aimed to identify the effect on the clinical management if POCUS was applied on unselected patients. Secondarily the study aimed to identify predictors of ultrasound changing management.

Methods: This study was a blinded observational single center trial. A basic whole body POCUS protocol was performed in extension to the physical examination. The blinded treating physicians were interviewed about the presumptive diagnosis and plan for the patient. Subsequently the physicians were unblinded to the POCUS results and asked to choose between five options regarding the benefit from POCUS results.

Results: A total of 403 patients were enrolled in this study. The treating physicians regarded POCUS examinations influence on the diagnostic workup or treatment as following: 1) No new information: 249 (61.8%), 2) No further action: 45 (11.2%), 3) Further diagnostic workup needed: 52 (12.9%), 4) Presumptive diagnosis confirmed 38 (9.4%), and 5) Immediate treatment needed: 19 (4.7%). Predictors of beneficial ultrasound were: (a) triage > 1, (b) patient comorbidities (cardiac disease, hypertension or lung disease), or (c) patients presenting with abdominal pain, dyspnea, or syncope.

Conclusion: POCUS was found to be potentially beneficial in 27.0% of all patients. High triage score, known cardiac disease, hypertension, pulmonary diseases, a clinical presentation with abdominal pain, dyspnea, or syncope are predictors of this. Future research should focus on patient-important outcomes when applying POCUS on these patients.

Trial registration: The trail was registered prior to patient inclusion with the Danish Data Protection Agency (https://www.datatilsynet.dk/ Case no: 1-16-02-603-14) and Clinical Trials (www.clinicaltrials.gov/ Protocol ID: DNVK1305018).

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Trial profile flowchart
Fig. 2
Fig. 2
Results from the interviews with physicians when they where unblinded to the results of the ultrasound examination. The figure also illustrates which answers were considered beneficial and which where not. Results are displayed as: n(%)[95% CI]
See this image and copyright information in PMC

References

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    1. Laursen CB, Sloth E, Lassen AT, Davidsen JR, Lambrechtsen J, Henriksen DP, et al. Does point-of-care ultrasonography cause discomfort in patients admitted with respiratory symptoms? Scand J Trauma Resusc Emerg Med. 2015;23:46. - PMC - PubMed
    1. Frederiksen CA, Juhl-Olsen P, Andersen NH, Sloth E. Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard. Scand J Trauma Resusc Emerg Med. 2013;21:87. - PMC - PubMed
    1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757. - PubMed
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