The purpose of this study is to determine whether point-of-care (bedside) ultrasound assists physicians in the evaluation and management of patients with syncope.
Syncope is one of the more common presentations to the Emergency Department, representing between 1.2-1.5% of all evaluated patients and up to 6% of admissions. Due to an often broad and overlapping differential diagnosis, syncope represents a disease entity that often requires extensive workup. This typically involves laboratory tests, EKGs, x-rays, computed tomography, or other studies that are costly, time-consuming, and, in the case of diagnostic imaging, frequently involves ionizing radiation. Yet, despite extensive testing, an exact diagnosis is not made in up to 50% of cases. Cardiac causes of syncope include myocardial infarction, pericardial effusion, volume depletion, arrhythmia, among other entities, many of which are life threatening. Echocardiography (cardiac ultrasound) has been used for inpatient syncope evaluations for several decades. In the Emergency Department, echocardiography is currently being used at the point-of-care (POC) in a limited and focused approach to a variety of conditions. However, POC ultrasound has never been systematically evaluated as a diagnostic or prognostic tool specifically for syncope in the Emergency Department. We aim to determine if an ultrasound-based protocol is effective as an adjunct in the evaluation of syncope. Our research study will examine the utility of POC ultrasound in the diagnosis, imaging and laboratory utilization, and prognosis of syncope in the Emergency Department.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
SINGLE
Enrollment
45
Performance of a focused cardiac ultrasound including a qualitative assessment of left ventricular function, pericardial effusion, right ventricular strain, proximal ascending aortic diameter, and inferior vena cava size and collapsibility
Yale New Haven Hospital
New Haven, Connecticut, United States
Time to Final Emergency Department Disposition
Time frame: Time at which an admit or discharge order is placed within the electronic medical record (estimated 2-3 hours)
Time to therapeutic intervention
Time frame: At onset of therapeutic interventions including but not limited to intravenous fluids and medications (estimated time frame 0 - 6 hours)
Time to clinical procedure
Time frame: At onset of clinical procedures including but not limited to central line placement, pericardiocentesis, thoracentesis, etc. (estimated time frame 0-6 hours)
Number and Type of other imaging studies
Other imaging studies to included radiographs, additional point-of-care ultrasound, computed tomography, etc.
Time frame: End of Emergency Department Encounter (estimated time frame 1- 6 hours)
Information Content provided by Point-of-Care Ultrasound
calculating from pre and post test probability estimates and the number of diagnoses
Time frame: After performance of point-of-care ultrasound (estimated time frame 1- 6 hours)
Number and type of laboratory studies
Time frame: estimated time frame 0-6 hours
Number of and time to consultant services
Number of consults obtained and the time frame in which the consults were performed
Time frame: estimated time frame (0-6 hours)
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