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Early Point-of-Care Ultrasound Assessment for Medical Patients Reduces Time to Appropriate Treatment: A Pilot Randomized Controlled Trial.
Ultrasound in Medicine & Biology ( IF 2.9 ) Pub Date : 2020-05-16 , DOI: 10.1016/j.ultrasmedbio.2020.03.023
Yael Ben-Baruch Golan 1 , Re'em Sadeh 2 , Yuval Mizrakli 2 , Tali Shafat 3 , Iftach Sagy 3 , Tzachi Slutsky 4 , Sergio L Kobal 5 , Victor Novack 6 , Lior Fuchs 3
Affiliation  

Numerous studies emphasize the diagnostic importance of point-of-care ultrasound (POCUS), but the level of evidence remains low as most data are gathered from observational studies. We conducted a pilot, randomized controlled trial to evaluate the effect of POCUS exam on medical patient's management and clinical outcomes. Patients presenting with chest pain or dyspnea were enrolled and randomly allocated to an early POCUS scan group and a control group. POCUS assessment, within 24 h of internal ward admission, was conducted only for the intervention group. The primary outcome was time to correct diagnosis. Secondary outcomes included time to appropriate treatment, POCUS-related rate of primary diagnosis alteration and new clinically relevant findings and time to hospital discharge. Sixty patients were enrolled. Thirty patients were randomly allocated to each study arm. The POCUS exam revealed clinically relevant findings among 79% of patients and led to alteration of the primary diagnosis among 28% of patients. Time to appropriate treatment was significantly shorter among patients in the POCUS group compared with the control group (median time of 5 h [95% confidence interval: 0.5–9] vs. 24 h [95% CI: 19–29] p = 0.014). The time needed to achieve correct diagnosis by the primary team was shorter in the POCUS group compared with the control group, yet it did not reach statistical significance (median time of 24 h [95% CI: 18–30] vs. 48 h [95% CI: 20–76], p = 0.12). These results indicate that POCUS assessment conducted early among patients with dyspnea or chest pain improves diagnostic accuracy and shortens significantly the time to appropriate treatment.



中文翻译:

医疗患者的早期床旁超声评估减少了适当治疗的时间:一项试点随机对照试验。

许多研究强调了床旁超声 (POCUS) 的诊断重要性,但由于大多数数据是从观察性研究中收集的,因此证据水平仍然很低。我们进行了一项试点、随机对照试验,以评估 POCUS 检查对内科患者管理和临床结果的影响。出现胸痛或呼吸困难的患者被纳入并随机分配到早期 POCUS 扫描组和对照组。入院后 24 小时内仅对干预组进行 POCUS 评估。主要结果是纠正诊断的时间。次要结果包括适当治疗的时间、POCUS 相关的初步诊断改变率和新的临床相关发现以及出院时间。招募了 60 名患者。30 名患者被随机分配到每个研究组。POCUS 检查在 79% 的患者中揭示了临床相关的发现,并导致 28% 的患者改变了初步诊断。与对照组相比,POCUS 组患者的适当治疗时间显着缩短(中位时间为 5 小时 [95% 置信区间:0.5-9] vs. 24 小时 [95% CI:19-29])p  = 0.014)。与对照组相比,POCUS 组初级团队获得正确诊断所需的时间更短,但没有达到统计学显着性(中位时间 24 小时 [95% CI:18-30] vs. 48 小时 [ 95% CI:20–76],p  = 0.12)。这些结果表明,在呼吸困难或胸痛患者中早期进行 POCUS 评估可提高诊断准确性并显着缩短适当治疗的时间。

更新日期:2020-06-25
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