Ienghong Kamonwon, Cheung Lap Woon, Tiamkao Somsak, Bhudhisawasdi Vajarabhongsa, Apiratwarakul Korakot
Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong.
J Multidiscip Healthc. 2023 Jan 24;16:219-226. doi: 10.2147/JMDH.S396986. eCollection 2023.
Globally, emergency departments (ED) are faced with an overcrowding problem. This issue is further compounded due to the multitude of contributing factors. Point of Care ultrasound (POCUS), especially when performed in prehospital care, that is before the patient is admitted to the ED has a high potential to reduce time of diagnosis and time of investigation which leads to shorter ED length of stay (LOS). The primary focus was on variances in ED LOS between the prehospital POCUS group and the standard care group.
A cross-sectional study was conducted on prehospital patients who were admitted to the ED at Srinagarind Hospital, Thailand, from January to December 2021. We divided patients into two groups including patients who obtained prehospital POCUS (the prehospital POCUS group) and patients who received standard care treatment in which there was no prehospital POCUS performed (the standard care group). POCUS and ED medical records were documented and submitted for analysis.
Of 1348 prehospital patients, 840 were enrolled in this study: 169 with prehospital POCUS and 671 with standard care. Median LOS in the prehospital POCUS group was 159 min (IQR 89,289) versus 165 (IQR 102,330) in the standard care group (p = 0.125). Further imaging diagnostic test which affected ED LOS more than four hours was lower in the prehospital POCUS group (adjusted odds ratio [OR], 0.92; 95% confidence intervals [CI], 0.729-1.666) than in the standard care group. The factor associated with increased odds of ED LOS more than four hour in the prehospital POCUS group was admission to hospital (adjusted OR 1.88; 95% CI, 1.230-2.239).
Patients evaluated with prehospital POCUS had a shorter LOS than the only standard care treatment without statistical significance.
在全球范围内，急诊科（ED）面临着过度拥挤的问题。由于众多促成因素，这个问题进一步恶化。床旁即时超声检查（POCUS），特别是在院前护理中进行，即在患者被收入急诊科之前进行，具有很大潜力减少诊断时间和检查时间，从而缩短急诊科住院时间（LOS）。主要关注点是院前POCUS组和标准护理组之间急诊科LOS的差异。
对2021年1月至12月在泰国诗里拉吉医院被收入急诊科的院前患者进行了一项横断面研究。我们将患者分为两组，包括接受院前POCUS检查的患者（院前POCUS组）和接受未进行院前POCUS的标准护理治疗的患者（标准护理组）。记录并提交POCUS和急诊科医疗记录以供分析。
在1348名院前患者中，840名被纳入本研究：169名接受院前POCUS检查，671名接受标准护理。院前POCUS组的中位LOS为159分钟（四分位间距89,289），而标准护理组为165分钟（四分位间距102,330）（p = 0.125）。在院前POCUS组中，对急诊科LOS影响超过四小时的进一步影像学诊断检查低于标准护理组（调整后的优势比[OR]，0.92；95%置信区间[CI]，0.729 - 1.666）。院前POCUS组中与急诊科LOS超过四小时几率增加相关的因素是入院（调整后的OR 1.88；95% CI，1.230 - 2.239）。
接受院前POCUS评估的患者住院时间比仅接受标准护理治疗的患者短，但无统计学意义。
