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

M J Blans,E Bousie,J G Van Der Hoeven,F H Bosch

doi:10.1186/s13089-021-00229-3

Abstract

BackgroundPoint-of-care ultrasound (POCUS) has proven itself in many clinical situations. Few data on the use of POCUS during Medical Emergency Team (MET) calls exist. In this study, we hypothesized that the use of POCUS would increase the number of correct diagnosis made by the MET and increase MET’s certainty.MethodsSingle-center prospective observational study on adult patients in need for MET assistance. Patients were included in blocks (weeks). During even weeks, the MET physician performed a clinical assessment and registered an initial diagnosis. Subsequently, the POCUS protocol was performed and a second diagnosis was registered (US+). During uneven weeks, no POCUS was performed (US−). A blinded expert reviewed the charts for a final diagnosis. The number of correct diagnoses was compared to the final diagnosis between both groups. Physician’s certainty, mortality and possible differences in first treatment were also evaluated.ResultsWe included 100 patients: 52 in the US + and 48 in the US− group. There were significantly more correct diagnoses in the US+ group compared to the US− group: 78 vs 51% (P = 0.006). Certainty improved significantly with POCUS (P < 0.001). No differences in 28-day mortality and first treatment were found.ConclusionsThe use of thoracic POCUS during MET calls leads to better diagnosis and increases certainty.Trial registration. ClinicalTrials.gov. Registered 12 July 2017, NCT03214809 https://www.clinicaltrials.gov/ct2/show/NCT03214809?term=metus&cntry=NL&draw=2&rank=1

Highlights

Point-of-care ultrasound (POCUS) has proven itself in many clinical situations
We found that the number of correct diagnosis increased in the US+ group after the use of POCUS and that POCUS increased Medical Emergency Team (MET) physician’s certainty significantly
There are multiple studies evaluating the use of POCUS in the intensive care unit (ICU) and emergency room (ER) department, until now only two studies focused on the use of POCUS during MET calls

Summary

Introduction

Few data on the use of POCUS during Medical Emergency Team (MET) calls exist. We hypothesized that the use of POCUS would increase the number of correct diagnosis made by the MET and increase MET’s certainty. Medical Emergency Teams (METs) are called to the bedside when patients on hospital wards deteriorate. The MET physician will use a combination of history, physical examination and point-of-care laboratory tests to assess the patient. Blans et al Ultrasound J (2021) 13:29 has been found in a study on ER patients [5] and improving certainty might be important to attending MET physicians. Because most MET calls are requested for respiratory and or hemodynamic deterioration [15], we designed a POCUS protocol consisting of cardiac and lung (thoracic) ultrasound

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Results

Conclusion