Abstract
Study objective
Nontraumatic shock in the emergency department (ED) has multiple causes and carries
in-hospital mortality approaching 20%, underscoring the need for prompt diagnosis
and treatment. Diagnostic ultrasonography at the point of care is one method that
may improve the ability of ED physicians to quickly diagnose and treat. This study
assesses the effect of the use and timing of point-of-care (POC) ultrasonography on
time to disposition request.
Methods
This retrospective study across 4 Connecticut EDs compared propensity score matched
shock patients who did and did not receive POC ultrasonography. Two propensity score
matches were performed: the first using covariates of time to disposition from previous
literature and the second using 25 novel covariates identified from electronic health
records using machine learning to reduce variable selection biases.
Results
A total of 3834 unique patients presented with shock during an 18-month period, and
703 (18.3%) patients received POC ultrasonography. Mean time to disposition for all
patients was 255.4 minutes (interquartile range, 163.8). After propensity score matching, patients had
a mean reduction of 26.7 minutes (95% confidence interval [CI], 2.8-58.3) in time to disposition when POC ultrasonography
was performed within 1 hour of ED arrival and a lesser reduction of 16.7 minutes (95% CI, −2.8 to 35.5) when POC ultrasonography was performed within 2 hours. There was no evidence of reduction in time to disposition when ultrasonography
was performed after 2 hours (16.7 minutes; 95% CI, −14.3 to 29.9). Propensity score models using machine learning–selected variables yielded
similar results.
Conclusion
Performance of POC ultrasonography likely improves time to disposition when performed
early on ED patients with shock.
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Article Info
Publication History
Published online: February 26, 2016
Accepted:
February 23,
2016
Received:
February 1,
2016
Footnotes
☆Disclosures: Dr Moore has consulted for Sonosite Inc (now a subsidiary of FujiFilm Inc) and was paid by Phillips Healthcare to develop an educational product on echocardiography.
☆☆Financial support: no support.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
