Background
Methods
Study outline
Inclusion criteria
Sample size estimation
Ultrasound examinations
Cardiac ultrasound | FAST | Lung ultrasound | Abdominal ultrasound |
---|---|---|---|
Subxiphoid four chamber view | Right upper quadrant | Volpicelli’s eight anterolateral zones | Gallbladder longitudinal |
Parasternal long axis view | Left upper quadrant | Aorta transverse view | |
Parasternal short axis view | Transverse view of the bladder | Kidneys longitudinal bilateral | |
Apical four chamber view | Sagittal | Bladder as in FAST | |
Left ventricle contractility | Intra peritoneal free fluid | Pleural effusion | Dilated Urinary bladder |
Dilated right ventricle | Pneumothorax | Abdominal Aortic Aneurism | |
Pericardial fluid | Interstitial syndrome | Hydronephrosis | |
Parenchymal pathology Localized multiple B-lines | Cholecystolithiasis |
Primary outcome
Secondary outcomes
Statistics
Results
Characteristic | Total (n = 403) |
---|---|
Age, median (IQR) | 55.7 (38.5; 70.1) |
Male Gender, n(%) | 247 (61,3) |
BMI, median (IQR) | 25.4 (22.9; 29.0) |
BP systolic, mean (SD) | 142.1 (25.6) |
BP diastolic, mean (SD) | 84.9 (14.9) |
Temperature, median (IQR) | 37.0 (36.6; 37.3) |
Respiration rate, median (IQR) | 16 (16; 18) |
Heart rate mean (SD) | 76.1 (17.5) |
SpO2, median (IQR) | 98 (96; 99) |
Smoker n(%) | 53 (13.2) |
Alcohol abuse n(%) | 16 (4.0) |
Triage level | n(%) [95% CI] |
1 (blue) | 79 (19.6) [15.8; 23.8] |
2 (green) | 109 (27.1) [22.8; 31.7] |
3 (yellow) | 175 (43.4) [38.5; 48.4] |
4 (orange) | 34 (8.4) [5.9; 11.6] |
5 (red) | 6 (1.5) [0.5; 3.2] |
Known comorbidity | n(%) [95% CI] |
Hypertension | 74 (18.4) [14.7; 22.5] |
Cardiac disease | 68 (16.9) [13.3; 20.9] |
Pulmonary disease | 40 (9.9) [7.2; 13.3] |
Diabetes | 32 (7.9) [5.5; 11.0] |
Cancer | 9 (2.2) [1.0; 4.2] |
None of the above | 180 (44.7) [39.7; 49.7] |
Clinical presentation | n (%) [95% CI] |
Orthopedic complaint | 110 (27.3) [23.0; 31.9] |
Abdominal pain | 108 (26.8) [22.5; 31.4] |
Chest pain | 41 (10.2) [7.4; 13.5] |
Dyspnea | 40 (9.9) [7.2; 13.3] |
Traffic accident | 28 (6.9) [4.7; 9.9] |
Unexpected fall/syncope | 26 (6.5) [4.3; 9.3] |
Dizziness | 11 (2.7) [1.4; 4.8] |
Fever | 5 (1.2) [0.4; 2.9] |
Chest trauma | 3 (0.7) [0.2; 2.2] |
Abdominal trauma | 1 (0.2) [0.0; 1.4] |
Other | 94 (23.3) [19.3; 27.8] |
Overall changes in management
Secondary endpoints
Variable | Patients n | Beneficial ultrasound n (%) | Crude analysis | Adjusted analysis | ||||
---|---|---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | |||
Triage level | ||||||||
1 (ref) | 79 | 2 (2.5) | 1 | – | – | – | – | – |
2 | 109 | 32 (29.4) | 16.0 | (3.7; 69.1) | < 0.001 | 16.1 | (3.7; 71.6) | < 0.001 |
3 | 175 | 56 (32.0) | 18.1 | (4.3; 76.4) | < 0.001 | 17.6 | (4.1; 75.8) | < 0.001 |
4 | 34 | 16 (47.1) | 34.2 | (7.2; 162.4) | < 0.001 | 35.4 | (7.2; 173.7) | < 0.001 |
5 | 6 | 3 (50.0) | 38.5 | (4.5; 323.6) | 0.001 | 24.1 | (2.4; 243.7) | 0.007 |
Comorbidity | ||||||||
None (ref) | 251 | 45 (17.9) | 1 | – | – | – | – | – |
Cardiac disease | 68 | 31 (45.6) | 2.4 | (1.4; 4.2) | 0.003 | 2.3 | (1.3; 4.3) | 0.006 |
Hypertension | 77 | 32 (41.6) | 2.3 | (1.3; 4.0) | 0.005 | 2.4 | (1.3; 4.4) | 0.005 |
Pulmonary disease | 40 | 22 (55.0) | 3.5 | (1.7; 7.0) | < 0.001 | 2.9 | (1.4; 6.2) | 0.004 |
Cancer | 9 | 5 (55.6) | 2.2 | (0.5; 9.4) | 0.302 | 3.2 | (0.6; 17.3) | 0.171 |
Diabetes | 32 | 10 (31.3) | 0.7 | (0.3; 1.7) | 0.479 | 0.6 | (0.2; 1.4) | 0.208 |
Training level | ||||||||
Specialist physician (ref) | 85 | 20 (23.5) | 1 | – | – | |||
3rd year resident | 64 | 21 (32.8) | 1.6 | (0.8; 3.3) | 0.211 | |||
1st year resident | 254 | 68 (26.7) | 1.2 | (0.7; 2.1) | 0.555 |
Variable | Patients n | Beneficial ultrasound n (%) | Crude analysis | Adjusted analysis | ||||
---|---|---|---|---|---|---|---|---|
OR | 95% CI | p-value | OR | 95% CI | p-value | |||
Clinical presentation | ||||||||
Abdominal pain | 108 | 47 (43.5) | 5.0 | (2.0; 12.2) | < 0.001 | 5.2 | (2.0; 13.4) | 0.001 |
Chest pain | 41 | 13 (31.7) | 0.7 | (0.3; 1.9) | 0.554 | 0.9 | (0.4; 2.2) | 0.797 |
Fever | 5 | 5 (100) | – | – | – | – | – | – |
Chest trauma | 3 | 1 (33.3) | 4.0 | (0.3; 50.8) | 0.287 | 5.7 | (0.4; 77.7) | 0.191 |
Abdominal Trauma | 1 | 0 (0) | – | – | – | – | – | – |
Dyspnea | 40 | 26 (65.0) | 11.7 | (4.3; 31.9) | < 0.001 | 10.6 | (3.6; 31.2) | < 0.001 |
Syncope | 26 | 9 (34.6) | 2.9 | (1.0; 8.4) | 0.044 | 3.3 | (1.1; 10.2) | 0.038 |
Dizziness | 11 | 5 (45.4) | 4.8 | (1.1; 20.5) | 0.036 | 3.4 | (0.7; 15.5) | 0.113 |
Traffic accident | 28 | 3 (10.7) | 0.9 | (0.2; 3.6) | 0.835 | 0.9 | (0.2; 3.9) | 0.912 |
Minor orthopedic complaint | 110 | 10 (9.1) | 0.7 | (0.3; 2.1) | 0.559 | 1.7 | (0.5; 5.5) | 0.371 |
All Other | 95 | 24 (25.3) | 1.4 | (0.7; 3.1) | 0.370 | 1.4 | (0.6; 3.3) | 0.407 |