The effect of point-of-care ultrasound on length of stay and mortality in patients with chest pain/dyspnea

Abstract

Purpose This study aims to investigate the effects of point-of-care ultrasound (PoCUS) on length of stay (LOS) and mortality in hemodynamically stable patients with chest pain/dyspnea.

Materials and Methods The prospective study was conducted from June 2020 to May 2021. A convenience sample of adult non-traumatic patients with chest pain/dyspnea was included and evaluated by PoCUS. The primary outcome was the relationship between the door-to-PoCUS time and LOS/mortality categorized by the ST-segment elevation (STE) and non-STE on the initial electrocardiogram. The diagnostic accuracy of PoCUS was computed, compared to the final diagnosis.

Results A total of 465 patients were included. 3 of 18 patients with STE had unexpected cardiac tamponade and 1 had myocarditis with pulmonary edema. PoCUS had a minimal effect on LOS and mortality in patients with STE. In the non-STE group, the shorter door-to-PoCUS time was associated with a shorter LOS (coefficient, 1.26±0.47, p=0.008). After categorizing the timing of PoCUS as 30, 60, 90, and 120 minutes, PoCUS had a positive effect, especially when performed within 90 minutes of arrival, on LOS of less than 360 minutes (OR, 2.42, 95% CI, 1.61–3.64) and patient survival (OR, 3.32, 95% CI, 1.14–9.71). The overall diagnostic performance of PoCUS was 96.6% (95% CI, 94.9–98.2%), but lower efficacy occurred in pulmonary embolism and myocardial infarction.

Conclusion The use of PoCUS was associated with a shorter LOS and less mortality in patients with non-STE, especially when performed within 90 minutes of arrival. Although the effect on patients with STE was minimal, PoCUS played a role in discovering unexpected diagnoses.

Zusammenfassung

Ziel Diese Studie zielt darauf ab, die Auswirkungen des Point-of-Care-Ultraschalls (PoCUS) auf die Verweildauer und die Mortalität bei hämodynamisch stabilen Patienten mit Brustschmerz/Dyspnoe zu untersuchen.

Material und Methoden Diese prospektive Studie wurde von Juni 2020 bis Mai 2021 durchgeführt. Es wurde eine Zufallsstichprobe erwachsener, nicht traumatischer Patienten mit Brustschmerz/Dyspnoe einbezogen und mittels PoCUS untersucht. Das primäre Outcome war die Beziehung zwischen der „Door-to-PoCUS“-Zeit und der Verweildauer/Mortalität, kategorisiert nach ST-Strecken-Hebung (STE) und Nicht-STE im initialen Elektrokardiogramm. Die diagnostische Genauigkeit des PoCUS wurde berechnet und mit der End-Diagnose verglichen.

Ergebnisse Insgesamt wurden 465 Patienten eingeschlossen. Drei von 18 Patienten mit STE hatten eine unerwartete Herztamponade und 1 Patient hatte eine Myokarditis mit Lungenödem. PoCUS hatte bei Patienten mit STE einen minimalen Einfluss auf die Verweildauer und die Mortalität. In der Gruppe der Nicht-STE-Patienten war die kürzere „Door-to-PoCUS“-Zeit mit einer kürzeren Verweildauer verbunden (Koeffizient: 1,26 ±0,47; p=0,008). Bei einer Kategorisierung der Terminierung der PoCUS-Untersuchung innerhalb von 30, 60, 90 und 120 Minuten hatte PoCUS einen positiven Effekt auf die Verweildauer von weniger als 360 Minuten (OR: 2,42; 95% CI: 1,61–3,64) und das Überleben der Patienten (OR: 3,32; 95% CI: 1,14–9,71), insbesondere, wenn er innerhalb von 90 Minuten nach Ankunft durchgeführt wurde. Die diagnostische Gesamtleistung von PoCUS betrug 96,6% (95% CI: 94,9–98,2%), wobei die Wirksamkeit bei Lungenembolie und Myokardinfarkt geringer war.

Schlussfolgerung Der Einsatz von PoCUS war mit einer kürzeren Verweildauer und einer geringeren Mortalität bei Patienten mit Nicht-STE verbunden, insbesondere, wenn er innerhalb von 90 Minuten nach Ankunft durchgeführt wurde. Obwohl die Auswirkungen auf Patienten mit STE minimal waren, spielte PoCUS eine Rolle bei der Entdeckung unerwarteter Diagnosen.

Keywords

Point of care - Echocardiography - Chest

Publication History

Received: 27 June 2022

Accepted after revision: 20 February 2023

Article published online:
18 April 2023

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