Emergency Department, National Taiwan University Hospital, Taipei, Taiwan.
Ultraschall Med. 2023 Aug;44(4):389-394. doi: 10.1055/a-2048-6274. Epub 2023 Apr 18.
This study aims to investigate the effects of point-of-care ultrasound (PoCUS) on length of stay (LOS) and mortality in hemodynamically stable patients with chest pain/dyspnea.
The prospective study was conducted from June 2020 to May 2021. A convenience sample of adult non-traumatic patients with chest pain/dyspnea was included and evaluated by PoCUS. The primary outcome was the relationship between the door-to-PoCUS time and LOS/mortality categorized by the ST-segment elevation (STE) and non-STE on the initial electrocardiogram. The diagnostic accuracy of PoCUS was computed, compared to the final diagnosis.
A total of 465 patients were included. 3 of 18 patients with STE had unexpected cardiac tamponade and 1 had myocarditis with pulmonary edema. PoCUS had a minimal effect on LOS and mortality in patients with STE. In the non-STE group, the shorter door-to-PoCUS time was associated with a shorter LOS (coefficient, 1.26±0.47, p=0.008). After categorizing the timing of PoCUS as 30, 60, 90, and 120 minutes, PoCUS had a positive effect, especially when performed within 90 minutes of arrival, on LOS of less than 360 minutes (OR, 2.42, 95% CI, 1.61-3.64) and patient survival (OR, 3.32, 95% CI, 1.14-9.71). The overall diagnostic performance of PoCUS was 96.6% (95% CI, 94.9-98.2%), but lower efficacy occurred in pulmonary embolism and myocardial infarction.
The use of PoCUS was associated with a shorter LOS and less mortality in patients with non-STE, especially when performed within 90 minutes of arrival. Although the effect on patients with STE was minimal, PoCUS played a role in discovering unexpected diagnoses.
本研究旨在探讨即时超声（PoCUS）对胸痛/呼吸困难血流动力学稳定患者的住院时间（LOS）和死亡率的影响。
前瞻性研究于 2020 年 6 月至 2021 年 5 月进行。纳入了方便抽样的成年非创伤性胸痛/呼吸困难患者，并通过 PoCUS 进行评估。主要结局是根据初始心电图上 ST 段抬高（STE）和非 STE 将门到 PoCUS 时间与 LOS/死亡率进行分类的关系。比较了 PoCUS 的诊断准确性与最终诊断。
共纳入 465 例患者。18 例 STE 患者中有 3 例出现意外心脏压塞，1 例出现心肌炎合并肺水肿。PoCUS 对 STE 患者的 LOS 和死亡率影响较小。在非 STE 组中，门到 PoCUS 时间越短，LOS 越短（系数为 1.26±0.47，p=0.008）。将 PoCUS 的时间分为 30、60、90 和 120 分钟后，PoCUS 具有积极的效果，特别是在到达后 90 分钟内进行时，对 LOS 小于 360 分钟（OR，2.42，95%CI，1.61-3.64）和患者生存（OR，3.32，95%CI，1.14-9.71）有积极影响。PoCUS 的总体诊断性能为 96.6%（95%CI，94.9-98.2%），但在肺栓塞和心肌梗死中的疗效较低。
非 STE 患者使用 PoCUS 可缩短 LOS 和降低死亡率，尤其是在到达后 90 分钟内进行时。虽然对 STE 患者的影响较小，但 PoCUS 在发现意外诊断方面发挥了作用。
