Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients

Alan E. Jones, Vivek S. Tayal, D. Matthew Sullivan, Jeffrey A. Kline

Research output: Contribution to journalArticle

259 Scopus citations

Abstract

Objective: We examined a physician-performed, goal-directed ultrasound protocol for the emergency department management of nontraumatic, symptomatic, undifferentiated hypotension. Design: Randomized, controlled trial of immediate vs. delayed ultrasound. Setting: Urban, tertiary emergency department, census > 100,000. Patents: Nontrauma emergency department patients, aged >17 yrs, and initial emergency department vital signs consistent with shock (systolic blood pressure <100 mm Hg or shock index >1.0), and agreement of two independent observers for at least one sign and symptom of inadequate tissue perfusion. Interventions: Group 1 (immediate ultrasound) received standard care plus goal-directed ultrasound at time 0. Group 2 (delayed ultrasound) received standard care for 15 mins and goal-directed ultrasound with standard care between 15 and 30 mins after time 0. Measurements and Main Results: Outcomes included the number of viable physician diagnoses at 15 mins and the rank of their likelihood of occurrence at both 15 and 30 mins. One hundred eighty-four patients were included. Group 1 (n = 88) had a smaller median number of viable diagnosis at 15 mins (median = 4) than did group 2 (n = 96, median = 9, Mann-Whitney U test, p < .0001. Physicians indicated the correct final diagnosis as most likely among their viable diagnosis list at 15 mins in 80% (95% confidence interval, 70-87%) of group 1 subjects vs. 50% (95% confidence interval, 40-60%) in group 2, difference of 30% (95% confidence interval, 16-42%). Conclusions: Incorporation of a goal-directed ultrasound protocol in the evaluation of nontraumatic, symptomatic, undifferentiated hypotension in adult patients results in fewer viable diagnostic etiologies and a more accurate physician impression of final diagnosis.

Original languageEnglish (US)
Pages (from-to)1703-1708
Number of pages6
JournalCritical care medicine
Volume32
Issue number8
DOIs
StatePublished - Aug 1 2004
Externally publishedYes

Keywords

  • Clinical trial
  • Diagnosis
  • Hypotension
  • Mortality
  • Shock
  • Ultrasound

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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