Point-of-care critical ultrasound in a rural emergency department

Point-of-care critical ultrasound (CCUS) has changed the management of critically ill patients in the emergency department. It is brought to the bed of patient, images are immediately available and therapy can be monitored making real time changes. Although it is difficult to estimate the real efficacy of CCUS, we evaluated the impact of ultrasound in our emergency department. This study is a cross sectional observational study with 241 cases enrolled. All patients were evaluated by the emergency physician and underwent clinical examination and then CCUS. Patients were then independently evaluated by at least one consultant. A final diagnosis was made after an agreement between the emergency physician and the consultant. Percentages of correct final diagnosis were higher after CCUS than after primary survey: 82.5% vs 49.1% of patients with dyspnea (P<0.001), 71.9% vs 40.6 % with thoracic pain (P=0.03), 76.2% vs 45% with abdominal pain (P<0.001), 80.0% vs 43.6% with suspected deep venous thrombosis (P=0.03) and 80.0% vs 20% with shock (P=0.014). Extended fast assessment for trauma was effective for the management of traumatic patients and correctly ruled out complications in 81.1% of patients (P=0.04). A small number of ultrasound guided invasive procedures were safely and successfully performed. In our study the integration of primary survey with CCUS increased diagnostic capability of the emergency physician and improved overall quality of medical assistance.