Abstract
IntroductionPoint-of-care ultrasound (POCUS) is an essential tool in the timely evaluation of an undifferentiated patient in the emergency department (ED). Our primary objective in this study was to determine the perceived impact of POCUS in high-risk cases presented at emergency medicine (EM) morbidity and mortality (M&M) conferences. Additionally, we sought to identify in which types of patients POCUS might be most useful, and which POCUS applications were considered to be highest yield.MethodsThis was a retrospective survey of cases submitted to M&M at an EM residency program that spans two academic EDs, over one academic year. Postgraduate year 4 (PGY) residents who presented M&M cases at departmental sessions were surveyed on perceived impacts of POCUS on individual patient outcomes. We evaluated POCUS use and indications while the POCUS was used.ResultsOver the 12-month period, we reviewed 667 cases from 18 M&M sessions by 15 PGY-4 residents and a supervising EM attending physician who chairs the M&M committee. Of these cases, 75 were selected by the M&M committee for review and presentation. POCUS was used in 27% (20/75) of the cases and not used in 73% (55/75). In cases where POCUS was not used, retrospective review determined that if POCUS had been used it would have “likely prevented the M&M” in 45% (25/55). Of these 25 cases, the majority of POCUS applications that could have helped were cardiac (32%, 8/25) and lung (32%, 8/25) ultrasound. POCUS was felt to have greatest potential in identifying missed diagnoses (92%, 23/25), and decreasing the time to diagnosis (92%, 23/25). Patients with cardiopulmonary chief complaints and abnormal vital signs were most likely to benefit. There were seven cases (35%, 7/20, 95% CI 15–59%) in which POCUS was performed and thought to have possibly adversely affected the outcome of the M&M.ConclusionPOCUS was felt to have the potential to reduce or prevent M&M in 45% of cases in which it was not used. Cardiac and lung POCUS were among the most useful applications, especially in patients with cardiopulmonary complaints and in those with abnormal vital signs.
Highlights
Point-of-care ultrasound (POCUS) is an essential tool in the timely evaluation of an undifferentiated patient in the emergency department (ED)
There were seven cases (35%, 7/20, 95% confidence intervals (CI) 15-59%) in which POCUS was performed and thought to have possibly adversely affected the outcome of the morbidity and mortality (M&M)
In critical care patients this is further exemplified as one study showed that upwards of 10% of intensive care unit (ICU) patients had lethal misdiagnoses on autopsy.[3]
Summary
Point-of-care ultrasound (POCUS) is an essential tool in the timely evaluation of critically ill patients and those with undifferentiated diagnoses. For this reason, POCUS training is a growing part of medical education, in emergency medicine (EM) where accreditation training requirements exist, and residents are required by the Accreditation Council for Graduate Medical Education to demonstrate POCUS competency.[4] the American College of Emergency Physicians has released a policy statement including guidelines and recommendations for POCUS education for emergency physicians.[5] Successful implementation of POCUS requires emergency physicians to acquire and interpret images, as well as apply and integrate these interpretations into clinical practice
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