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Prognostic Implications of a Point‐of‐Care Ultrasound Examination on Hospital Ward Admission
Author(s) -
Kimura Bruce J.,
Lou May M.,
Dahms Eric B.,
Han Paul J.,
Waalen Jill
Publication year - 2020
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.15102
Subject(s) - medicine , confidence interval , odds ratio , univariate analysis , medical record , sepsis , multivariate analysis , emergency medicine
Objectives Few data exist regarding the use of ultrasound (US) to risk stratify ward admissions. Therefore, we evaluated associations between a cardiopulmonary limited ultrasound examination (CLUE) on admission and subsequent hospital outcomes. Methods Over a 22‐month period in a 300‐bed hospital, CLUE data reviewed from a series of nonelective ward admissions were correlated with the composite outcome of a hospital stay of longer than 2 days, disposition to hospice, or death. The CLUE included 5 quick‐look signs of left ventricular dysfunction, left atrial enlargement, lung B‐lines, pleural effusions, and inferior vena cava plethora and had been performed as warranted by 1 of 31 US‐trained admitting residents and then repeated by a cardiologist as the reference standard. The admitting condition, medical history, results of routine admission testing, and CLUE were assessed for an association with the outcome in univariate and multivariable models. Results Of 547 patients, the mean age ± SD was 62.9 ± 15.5 years; 59% were male; and the mean stay was 5.6 ± 8.1 days, with 355 (65%) lasting longer than 2 days and 21 (4%) having hospice disposition or death. An abnormal CLUE exam was found in 368 (67%) of patients, was related to the outcome (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.23–2.68; P = .001) when obtained by a resident or cardiologist, and was included in a best‐fit multivariable model with renal failure (OR, 2.44; 95% CI, 1.44–4.14; P < .001), infection/sepsis (OR, 2.25; 95% CI, 1.17–4.32; P = .02), and chest pain (OR, 0.36; 95% CI, 0.21–0.61; P < .001). Conclusions An abnormal admission point of care ultrasound exam was related to complex hospitalization, specifically a longer length of stay.