Does Point‐of‐Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC‐ED Investigators
Abstract
Study objective Point‐of‐care ultrasonography protocols are commonly used in the initial management of patients with undifferentiated hypotension in the emergency department (ED). There is little published evidence for any mortality benefit. We compare the effect of a point‐of‐care ultrasonography protocol versus standard care without point‐of‐care ultrasonography for survival and clinical outcomes. Methods This international, multicenter, randomized controlled trial recruited from 6 centers in North America and South Africa and included selected hypotensive patients (systolic blood pressure 1) randomized to early point‐of‐care ultrasonography plus standard care versus standard care without point‐of‐care ultrasonography. Diagnoses were recorded at 0 and 60 minutes. The primary outcome measure was survival to 30 days or hospital discharge. Secondary outcome measures included initial treatment and investigations, admissions, and length of stay. Results Follow‐up was completed for 270 of 273 patients. The most common diagnosis in more than half the patients was occult sepsis. We found no important differences between groups for the primary outcome of survival (point‐of‐care ultrasonography group 104 of 136 patients versus standard care 102 of 134 patients; difference 0.35%; 95% binomial confidence interval [CI] –10.2% to 11.0%), survival in North America (point‐of‐care ultrasonography group 76 of 89 patients versus standard care 72 of 88 patients; difference 3.6%; CI –8.1% to…
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: 270 participants or records.
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