Prospective trial to evaluate the impact on the initial therapeutic inadequacy of a management strategy for acute dyspnea in the elderly based on the use of lung and cardiac ultrasonography.
Acute dyspnea is a frequent and serious reason of admission in Emergency Department (ED), with a one-month mortality close to 16%. It is difficult to diagnose in the initial assessment phase since the cause of this symptom can vary (cardiological, pulmonary, infectious, etc.) and the symptoms can be misleading. This difficulty in diagnosing delays the implementation of appropriate therapeutic management even as the timeliness of management is associated with a reduction in mortality. These issues are particularly important in the elderly. Lung and cardiac ultrasonography performed by the emergency physician, immediately available at the patient's bedside, could reduce the diagnostic and therefore therapeutic delay. However, the impact of a diagnostic strategy based on lung and cardiac ultrasonography in dyspneic elderly subjects has not been evaluated. Patients will be randomized in two groups : "standard of care" or "clinical ultrasound" group. Treatments initiated in Emergency Department (ED) will be noted to be compared to final diagnosis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
SINGLE
Enrollment
504
cardiopulmonary ultrasound performed by the emergency physician, immediately at patient's bed
UHToulouse
Toulouse, France
RECRUITINGtherapeutic inadequacy
therapeutic inadequacy between initiated emergency treatments and the final diagnosis made by expert opinion
Time frame: Hour 1
correct diagnosis
correct diagnosis at the emergency department discharge (compared with final diagnosis made by expert opinion)
Time frame: emergency department discharge (up to hour 4)
duration of emergency department stay
duration in emergency department (in hours)
Time frame: emergency department discharge (up to hour 4)
Post-emergency hospital stay
duration in Post-emergency hospital department: in medicine/surgery/obstetrics or follow-up and rehabilitation care (in days)
Time frame: Day 30
Number of days alive outside hospital between D0 and D30
Number of days alive outside hospital between D0 and D30
Time frame: Day 30
Care cost
Care cost - Direct and indirect medical cost looking at French social security spendings for patients
Time frame: Day 30
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