Effect of a point-of-care ultrasound-driven diagnostic pathway on diagnostic certainty in emergency department patients with dyspnea: a randomized controlled substudy
Abstract
Background and importance: In emergency department (ED) patients with dyspnea, diagnostic uncertainty has been linked to poorer outcomes. Point-of-care ultrasound (POCUS) may help reduce this uncertainty.
Objective: To explore how POCUS influences ED physicians' diagnostic thinking and perceived uncertainty.
Design, settings, and participants: This preplanned substudy of a randomized controlled trial across 10 Danish EDs compared diagnostic pathways with vs. without focused lung and cardiac ultrasound.
Outcomes measure and analysis: Paired physician surveys and electronic health record data were used to evaluate predefined outcomes: (a) physicians' experienced benefit of diagnostic tests; (b) the number of differential diagnoses; (c) posttest probability estimates; (d) concurrent treatment; and (e) concordance between tentative diagnoses. The primary outcome of the parent trial was discharge alive within 24 h; this substudy focused on early diagnostic reasoning and certainty.
Main results: Between 25 January 2023 and 23 August 2024, 40 physicians enrolled 674 patients. The median number of differential diagnoses was similar between groups [intervention: 3 (interquartile range - IQR: 2-4); control: 3 (IQR: 2-4)]. The proportion of patients with a reduced differential count was 65.3 vs. 72.9% [risk difference: -7.6, 95% confidence interval (CI): -14.9 to -0.3]. The median estimated probability of the leading diagnosis was higher with POCUS (80 vs. 73%). Concordance between…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 674 participants or records.
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