Dyspnea
Conditions
Keywords
Point-of-care Ultrasound, Emergency Medicine, Diagnostic pathways
Brief summary
The POCUS PATHWAY-trial is a multi-center, randomized, investigator-initiated, open labelled, pragmatic, controlled trial of a point-of-care ultrasound-driven diagnostic pathway vs standard diagnostic pathway in dyspneic emergency department patients. The primary outcome will be 24-hour hospital stay and 642 patients will be included. Key secondary outcomes include overall hospital length of stay, image resources, and 72-hour revisits.
Interventions
DIAGNOSTIC_TESTPoint-of-care ultrasound-driven diagnostic pathway
Focused lung ultrasound will include 8 zones (anterior and lateral) and evaluate pneumothorax, interstitial syndrome, lung consolidation, and pleural effusion. Focused cardiac ultrasound will include four views (subxiphoid four-chamber view, parasternal long-axis view, parasternal short-axis view, and apical four-chamber view) and evaluate pericardial fluid, right ventricle dilation, and left ventricular systolic contractility.
Sponsors
Aarhus University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Emergency department contact 2. Age ≥ 18 years 3. Chief complaint is Dyspnea 4. Including physician present
Exclusion criteria
1. Fulfilling of criteria for coded rapid-response teams (i.e., trauma, surgical or medical emergencies). 2. Prior focused lung or focused cardiac ultrasound in the current emergency department stay 3. Prior enrollment in the trial 4. Unable to consent 5. Non Danish-speaking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 24-hour hospital stay | From date of hospital admission until the date of first documented hospital discharge, assessed up to 24 hours. | Proportion of patients with a hospital lenght-of-stay of less than 24 hours. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hospital length-of-stay | From date of hospital admission until the date of first documented hospital discharge, assessed up to 3 months. | Hospital length-of-stay will secondarily be analyzed using time-to-event analysis. |
| Image resources | From date of hospital admission until the date of first documented hospital discharge, assessed up to 3 months. | Image resources will be presented as a composite absolute number and incidence proportion counting the cumulative number of participants having received any of the following imaging techniques during the current hospital stay: chest x-rays, echocardiography, computed tomography (CT) angiography, and CT thorax. |
| Number of participants with the composite outcome of 72-hour revisits and overall mortality | From date of hospital admission until 72 hours after the date of first documented hospital discharge, assessed up to 3 months. | 72-hour revisits will be defined as a composite outcome including any unplanned hospital stay within 72 hours from the previous hospital discharge, in-hospital mortality, and mortality within 72 hours from the previous hospital discharge. |
Countries
Denmark
Outcome results
None listed