305 The Frequency of Point-of-Care Ultrasound Use in the Treatment of Sepsis in the Emergency Department: A Retrospective Cohort Study

Abstract

A role for point-of-care ultrasound (POCUS) in the care of septic patients has been previously proposed; however, the degree to which POCUS has been integrated into sepsis care in the community emergency department (ED) is unknown. Our aim was to better understand the current role of POCUS in sepsis care by examining its frequency of use and the types of exams performed. This retrospective cohort study analyzed 5, 264 ED visits for sepsis across two community hospitals from January 2014 to December 2018. Patients 18 years or older with an ED diagnosis of sepsis and either lactate ≥4 mmol, a documented mean arterial pressure < 65mmHg, or a systolic blood pressure < 90mmHg were eligible for inclusion. Eligible encounters underwent chart review to determine if POCUS was used during their ED evaluation. Primary outcomes were frequency of POCUS use in the cohort, change in frequency of POCUS use over the study period, and the types of exams performed. Odds ratios (OR), confidence intervals (CI), and p-values (p) were calculated to assess relationships between variables and POCUS use. POCUS was used in 21% of encounters meeting inclusion criteria and was positively correlated with ED arrival year (OR=1.09; 95% CI: 1.04 - 1.15; p=0.001). The most common POCUS exam was for central venous catheter (CVC) placement (37%); however, use of this exam did not increase over the study period. The second and third most common exams performed were cardiac (18%) and inferior vena cava (IVC) exams (11%), respectively. Only the frequency of cardiac, IVC, lung and Focused Assessment with Sonography for Trauma (FAST) exams increased significantly over the study period. Certain patient characteristics, including obese BMI (OR=1.28; 95% CI: 1.10 - 1.49; p=0.002) and increased Charlson comorbidity index (OR=1.03; 95% CI: 1.00 - 1.05; p=0.03), were associated with increased odds of receiving POCUS. A code status of DNR prior to ED arrival conferred lower odds of receiving POCUS (OR=0.74; 95% CI: 0.62 - 0.90; p=0.002). POCUS use increased significantly over time in this cohort of septic patients. This suggests increasing incorporation of ultrasound into sepsis care and a potential role for cardiac, IVC, and lung exams in the evaluation and treatment of septic patients. Further studies are needed to assess the generalizability of these findings, and determine if POCUS use affects treatment decisions or patient outcomes.