Abstract
There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography (FCU) in the assessment of patients admitted with cardiopulmonary symptoms. To determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs. This is a prospective, parallel-group, superiority, randomized clinical trial with a 1:1 allocation ratio. The study was conducted at The Royal Melbourne Hospital, a tertiary public hospital located in Melbourne, Victoria, Australia. Adults aged 18 years or older admitted to the internal medicine ward with a cardiopulmonary diagnosis were enrolled between September 2018 and December 2019 and were followed up until hospital discharge. Data analysis was performed from August 2020 to January 2021. The intervention involved an internal medicine physician-performed heart, lung, and 2-point vein compression FCU in addition to standard clinical evaluation. The primary outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. A difference of 24 hours was defined as clinically important. Secondary outcomes included hospital readmissions at 30 days and hospital care costs. A total of 250 participants were enrolled and 2 were excluded, leaving 248 participants (mean [SD] age, 80.1 [11.0] years; 121 women [48.7%]) in the final analysis. There were 124 patients in the intervention group and 124 patients in the control group. The most common initial diagnoses were acute decompensated heart failure (113 patients [45.5%]), pneumonia (45 patients [18.1%]), and exacerbated chronic pulmonary disease (32 patients [12.9%]). The length of hospital stay was 113.4 hours (95% CI, 91.7-135.1 hours) in the FCU group and 125.3 hours (95% CI, 101.7-148.8 hours) in the control group (P = .53). The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan FCU of the heart, lungs, and lower extremities veins during their initial clinical assessment, did not have a shorter hospital length of stay by more than 24 hours, compared with patients who received standard care. Australian New Zealand Clinical Trials Registry Identifier: ACTRN12618001442291.
Highlights
Internal medicine physicians traditionally initiate their clinical evaluation on the basis of the patient’s medical history and physical examination findings
The 30-day readmission rate was not different between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 [95% CI, A$5586.1-A$10 076.1] vs A$7895.7 [95% CI, A$6385.9-A$9.405.5]). In this randomized clinical trial, adult patients admitted to an internal medicine ward with a cardiopulmonary diagnosis, who underwent multiorgan Focused clinical ultrasonography (FCU) of the
In a randomized clinical trial of 250 participants allocated to undergo multiorgan focused clinical ultrasonography or standard management at admission to the hospital, the hospital length of stay was not different compared with control patients. Meaning These findings suggest that integration of multiorgan focused clinical ultrasonography with the initial evaluation does not reduce hospital length of stay by more than 24 hours
Summary
Internal medicine physicians traditionally initiate their clinical evaluation on the basis of the patient’s medical history and physical examination findings. Focused clinical ultrasonography (FCU) has been shown to be a reliable and accurate test compared with the imaging reference standard.[6,7,8,9,10,11,12,13,14,15,16] FCU has the additional advantage of being free of ionizing radiation and performed in real-time at the patient’s bedside, increasing the speed and accuracy of the initial diagnosis[17] and avoiding the cost, time, and potential risk of transferring patients to other locations for investigations. This multiorgan FCU has demonstrated superiority to standard diagnostics tests alone for establishing the correct diagnosis within 4 hours in patients with respiratory symptoms presenting to the emergency department.[17]
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