A point-of-care ultrasound-driven diagnostic pathway for emergency department patients with dyspnoea: a randomised controlled trial

BACKGROUND: Previous trials have suggested that point-of-care ultrasound (POCUS) for emergency department (ED) patients with dyspnoea increases the proportion of patients discharged within 24 h. We aimed to assess whether this effect could be confirmed.

METHODS: This trial was a randomised controlled trial in 10 Danish EDs. Adult patients presenting to the ED with dyspnoea as chief complaint were randomised to the addition or omission of focused lung and cardiac ultrasound. The primary outcome was the proportion of patients discharged alive within 24 h. Secondary outcomes included overall hospital length of stay, chest imaging utilisation, and 72 h alive and revisit-free.

RESULTS: Among 674 patients who were randomised between 25 January 2023 and 23 August 2024, 663 were included in the analysis. The primary outcome occurred in 141 (42.6%) out of 331 patients in the intervention group versus 151 (45.5%) out of 332 in the control group (risk difference -2.9, 95% CI -10.4-4.7; p=0.45). The overall incidence rate of hospital discharges per person-days at risk was 0.28 in the intervention group versus 0.32 in the control group (hazard ratio 0.93, 95% CI 0.79-1.08; p=0.35).

CONCLUSIONS: In adult ED patients with dyspnoea as chief complaint, a POCUS-driven diagnostic pathway did not alter the proportion of patients discharged alive within 24 h or the overall hospital length of stay compared with standard care.