Damian McNamara

October 24, 2013

SEATTLE — Patients who require an ultrasound spend significantly less time waiting when imaged with a bedside device in the emergency department than when transferred to radiology, suggest preliminary findings of an ongoing prospective randomized controlled trial.

"These initial results suggest that pelvic ultrasound performed at bedside by emergency physicians could positively impact patient care by reducing time to diagnosis, patient wait time, and length of stay," Kiah Connolly, MD, from the University of California, Irvine, told Medscape Medical News.

Dr. Connolly and her colleague, Chanel Fischetti, a second year medical student, presented first results here at the American College of Emergency Physicians 2013 Scientific Assembly

Although often essential for diagnosis, pelvic ultrasounds can substantially extend the length of stay if patients have to wait for the radiology department, the researchers theorized.

In the ongoing study, pelvic ultrasound imaging is performed in the emergency department on even days and in the radiology department on odd days. Researchers record times from presentation to imaging and to discharge.

Women 18 years and older requiring an ultrasound for any pelvic presentation other than torsion are eligible to join the trial. However, only patients presenting between 6 in the morning and midnight are included, which is a potential limitation, Dr. Connolly noted.

A total of 84 participants were enrolled in the trial at the time these results were presented.

"There are a lot of benefits to performing the imaging at the bedside in the emergency department, including decreased length of stay and decreased costs, which make everything more efficient," said Fischetti during a moderated tour of the research forum ultrasound poster presentations. "Plus, patients get a diagnosis sooner."

Table. Wait Times for Pelvic Ultrasound

Outcome Emergency Department (n = 35) Radiology Department (n = 49) P Value
Average time to ultrasound (minutes) 5.7 71.1 <.0001
Total time in emergency department (hours) 4.06 5.81 .002

 

When asked about safety, Dr. Connolly explained that patients are evaluated for any "bounce back" to the emergency department within 2 weeks. In addition, all of the images are reviewed by coauthor Chris Fox, MD, emergency physician and director of instructional ultrasound at the University of California, Irvine.

"Even without looking at the data, we can say that length of stay is going to be shorter with point-of-care ultrasound," said Srikar Adhikari, MD, from the University of Arizona in Tucson, who was asked by Medscape Medical News to comment on the study. "We know we can do ultrasound in 15 minutes."

He suggested the researchers take additional factors into consideration. "They didn't look at all the variables, or other reasons why patients stayed in the emergency department."

The trial is ongoing and researchers plan to randomize 330 patients.

Dr. Connolly, Ms. Fischetti, and Dr. Adhikari have disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2013 Scientific Assembly: Abstract 217. Presented October 14, 2013.

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