Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial—the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study

Abstract

Background: Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design: A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion: This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020.

A proposed lung ultrasound and phenotypic algorithm for the care of COVID-19 patients with acute respiratory failure

“…42 A simpler approach using six zones has also been recently proposed. 43 The relevance of serial lung ultrasound has previously been reported in a small series of patients with ARDS 42 unrelated to the current COVID-19 pandemic but the various scoring systems would need comparing and validating in COVID-19 patients. In that study, the non-resolution of pulmonary lesions was associated with worse outcome.…”

Unusual cause of heart failure in the young, the intracardiac mass: Diagnostic dilemmas solved by echocardiography

“…An ongoing prospective randomized controlled trial evaluating the impact of POCUS on the length of hospital stays and diagnosis may provide more valuable evidence in the near future. 11 CMR imaging is often used synergistically with TTE, and provides complementary clinical information on myxomas or can be considered in the event where diagnostic uncertainty arises. 12 Meanwhile, the electrocardiogram and chest-X rays provide little to none diagnostic value.…”

Automatic Deep Learning-Based Consolidation/Collapse Classification in Lung Ultrasound Images for COVID-19 Induced Pneumonia

“…Lung ultrasound was performed using a Sonosite X-Porte portable ultrasound imaging system (Fujifilm, Bothell, WA, USA) with a 1-5 MHz phased array transducer. Lung ultrasound was standardized and followed the iLungScan protocol as established by The University of Melbourne, Ultrasound Education Group [27] and was performed by a physician trained and experienced in point of care lung ultrasound (XC) [26] and reviewed for diagnostic accuracy by an expert in lung ultrasound (DC, AR or CR). Patients were in a supine position for the examination, which was performed on all 3 anatomical zones of both lungs (Figure 1).…”