Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study

Abstract

Background Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809.

The Use of Handheld Ultrasound Devices in Emergency Medicine

“…Several preliminary studies suggest benefits of HHU use. These include reduced need for follow-up testing when used in the outpatient setting, with a low incidence of false negatives (5%), and faster time to diagnosis and reduced time to first intervention when HHUs were used by rapid response teams [ 66 , 67 ]. While image interpretability appears similar between HHUs and cart-based systems, a critical concept for future studies is not to conflate image quality and the setting of use with operator training and skills [ 68 ].…”

A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy

“…There are multiple studies evaluating the use of POCUS in the ICU and ER department, until now only two studies focused on the use of POCUS during MET calls. Zieleskiewicz et al published a paper [ 14 ] in which they evaluated the effect on diagnostic adequacy of thoracic POCUS during MET calls. As in our study, they found a significant increase in the number of correct diagnosis when POCUS was used (80% versus 94%).…”

“…The role of POCUS for instance during MET calls has not been investigated extensively yet, even though its role in the emergency room (ER) and intensive care unit (ICU) is well established [ 5 – 13 ]. Recently, Zieleskiewicz et al published the first prospective observational study on the effect of the use of a multi-organ POCUS protocol during MET calls [ 14 ]. In this study, the use of a multi-organ POCUS protocol improved diagnostic accuracy of the MET significantly.…”

Focal cardiac ultrasound learning with pocked ultrasound device: A bicentric prospective blinded randomized study

“…7,8 In a recent study, management of ward emergencies with a PUD showed an improvement in mortality (ref LZ). 9 For echocardiography, the position statement of the European Association of Cardiovascular Imaging is that the dissemination of appropriate PUD use is inevitable and desirable because of its potential impact on patient management. 9 In view of the increasing quality of these devices and POCUS development, some authors believe that PUD will supplant the stethoscope in the coming years.…”

“…9 For echocardiography, the position statement of the European Association of Cardiovascular Imaging is that the dissemination of appropriate PUD use is inevitable and desirable because of its potential impact on patient management. 9 In view of the increasing quality of these devices and POCUS development, some authors believe that PUD will supplant the stethoscope in the coming years. 10 To train physicians to use FoCUS with a PUD, it is unclear whether it is preferable to teach FoCUS to medical students using a PUD or a conventional ultrasound device (CUD).…”