Abstract
BackgroundPoint-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality.Methods/designA prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs.DiscussionThis study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020.Trial registrationAustralian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.
Highlights
Patients admitted to internal medicine wards with cardiorespiratory symptoms can be difficult to assess and treat as they are usually older, have multiple comorbidities, and take multiple medication
This study will evaluate the clinical impact of multi-organ Point-of-care ultrasound (POCUS) in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay
The primary aim of the study is to determine whether a heart, lung, and lower extremity vein POCUS reduces the length of hospital stay of patients admitted to internal medicine wards with a cardiopulmonary diagnosis by > 24 h
Summary
Patients admitted to internal medicine wards with cardiorespiratory symptoms can be difficult to assess and treat as they are usually older, have multiple comorbidities, and take multiple medication. Internal medicine physicians rely on the medical history and physical examination, collectively known as the clinical evaluation, to derive a differential diagnosis and formulate an initial management plan. The delay of making a precise diagnosis and starting an appropriate management could be detrimental for patient outcome. Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. There is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality
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