Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients with Undifferentiated Hypotension?

Atkinson PR, Milne J, Diegelmann L, et al. Ann Emerg Med. 2018 Oct;72(4):478-89. [CrossRef] [PubMed]

Point-of-care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED) or the intensive care unit (ICU). However, there is little published evidence for any mortality benefit. The authors compared a point-of-care ultrasonography protocol versus standard care without point-of-care ultrasonography for survival and clinical outcomes. Follow-up was completed for 270 of 273 patients. The most common diagnosis in more than half the patients was occult sepsis. No important differences between the two groups for 30-day survival. There were no important differences in rates of computed tomography (CT) scanning, inotrope or intravenous fluid use, and ICU or total length of stay. The authors conclude that addition of a point-of-care ultrasonography protocol to standard care may not translate into benefits in survival, length of stay, rates of CT scanning, inotrope use, or fluid administration.