Effect of a Point-of-Care Ultrasound-Driven vs Standard Diagnostic Pathway on 24-Hour Hospital Stay in Emergency Department Patients with Dyspnea-Protocol for A Randomized Controlled Trial

Stig Holm Ovesen; Søren Helbo Skaarup; Rasmus Aagaard; Hans Kirkegaard; Bo Løfgren; Michael Dan Arvig; Bo Martin Bibby; Stefan Posth; Christian B Laursen; Jesper Weile

doi:10.2147/OAEM.S454062

Effect of a Point-of-Care Ultrasound-Driven vs Standard Diagnostic Pathway on 24-Hour Hospital Stay in Emergency Department Patients with Dyspnea-Protocol for A Randomized Controlled Trial

Open Access Emerg Med. 2024 Aug 27:16:211-219. doi: 10.2147/OAEM.S454062. eCollection 2024.

Authors

Stig Holm Ovesen^{1

2}, Søren Helbo Skaarup³, Rasmus Aagaard⁴, Hans Kirkegaard¹, Bo Løfgren^{1

5}, Michael Dan Arvig^{6

7

8}, Bo Martin Bibby⁹, Stefan Posth¹⁰, Christian B Laursen^{11

12}, Jesper Weile^{1

2}

Affiliations

¹ Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
² Emergency Department, Horsens Regional Hospital, Horsens, Denmark.
³ Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
⁵ Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.
⁶ Emergency Department, Slagelse Hospital, Slagelse, Denmark.
⁷ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
⁹ Department of Biostatistics, Aarhus University, Aarhus, Denmark.
¹⁰ Emergency Department, Odense University Hospital, Odense, Denmark.
¹¹ Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
¹² Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.

Abstract

Purpose: Point-of-care ultrasound (POCUS) helps emergency department (ED) physicians make prompt and appropriate decisions, but the optimal diagnostic integration and potential clinical benefits remain unclear. We describe the protocol and statistical analysis plan for a randomized controlled trial. The objective is to determine the effect of a POCUS-driven diagnostic pathway in adult dyspneic ED patients on the proportion of patients having a hospital stay of less than 24 hours when compared to the standard diagnostic pathway.

Patients and methods: This is a multicenter, randomized, investigator-initiated, open-labeled, pragmatic, controlled trial. Adult ED patients with chief complaint dyspnea are eligible. Patients are randomized (1:1) to the POCUS-driven diagnostic pathway or standard diagnostic pathway, with 337 patients in each group. The primary outcome is the proportion of patients having a hospital stay (from ED arrival to hospital discharge) of less than 24 hours. Key secondary outcomes include hospital length-of-stay, 72-hour revisits, and 30-day hospital-free days.

Conclusion: Sparse evidence exists for any clinical benefit from a POCUS-integrated diagnostic pathway. The results from this trial will help clarify the promising signals for POCUS to influence patient care among ED patients with dyspnea.

Keywords: diagnostic effectiveness; focused cardiac ultrasound; focused lung ultrasound; shortness-of-breath.

Grants and funding

This study is funded by the Central Denmark Region (DKK 1,629,000), Frimodt-Heineke Foundation (DKK 40,000), Johan Schrøders Foundation (DKK 200,000), and Riisfort Foundation (DKK 211,858). The funding agencies have no role in designing or executing the study or interpreting, writing, or submitting the manuscript.