If you’re a #FOAM follower, you have probably seen the pleas for bedside ultrasound more than once. This paper takes an interesting approach to try and demonstrate its value in the diagnosis of aortic dissection: Over a two year period and 386,547 patient visits, there was a review of 123 medical reports and 194 autopsy reports, of which 32 patients were identified for inclusion. 16 received EP POCUS, 16 did not.
Median time to diagnosis – 80 minutes in the POCUS group vs 226 minutes in the non POCUS group. Misdiagnosis was 0% in the POCUS.
Mortality adjusted for DNR status: 15.4% vs 37.5%, POCUS vs non-POCUS.
Time to dispo? 134 minutes vs 205 minutes, POCUS vs non-POCUS. (and probably a much greater difference in time to *appropriate* disposition.)
[note that neither mortality or time to dispo was statistically significant]
With that said, I agree with the authors conclusions, (particularly in light of this previous post): “Patients who receive EP FOCUS are diagnosed faster and misdiagnosed less compared with patients who do not receive EP FOCUS. We recommend assessment of the thoracic aorta be performed routinely during cardiac ultrasound in the emergency department.”