Ultrasonography has been shown to be a useful tool for evaluating and treating adult sepsis patients in the emergency department, with physicians altering initial management plans based on point-of-care ultrasonographic data in more than 50 percent of cases, according to a study published online May 28 in the Annals of Emergency Medicine.
Study authors Samir A. Haydar, DO, MPH, and colleagues from Maine Medical Center in Portland, explained that patients with sepsis commonly present to the emergency department (ED), with reported mortality rates ranging from 40 to 60 percent. “However, there has been an encouraging decrease in sepsis-related mortality in recent years, in large part because of the development and implementation of protocols resulting in the early identification and aggressive management of these patients.”
These protocols promote aggressive patient management, according to the authors, and also raise concerns about adverse effects of treatment. Point-of-care ultrasonography provides intravascular volume status, which can help physicians plan treatments and spare some patients the risk of more invasive procedures.
To assess changes in clinical decision-making based on bedside ultrasonography, Haydar and colleagues performed a prospective before-and-after study involving patients with suspected sepsis. Point-of-care ultrasonography was used to determine cardiac contractility, inferior vena cava diameter and inferior vena cava collapsibility, as these dynamic measurements haven been suggested as accurate methods of determining fluid status. Physician reports were compared before and after knowledge of findings.
A total of 74 adult sepsis patients were enrolled. Their conditions ranged from sepsis (37 percent), severe sepsis (40 percent), septic shock (22 percent) and systemic inflammatory response syndrome (1 percent).
“After receipt of point-of-care ultrasonographic data, physicians altered the presumed primary cause of vital sign abnormalities in 12 cases [17 percent] and procedural intervention plans in 20 cases [27 percent],” reported the authors. Overall treatment plans were changed in 53 percent of cases.
Physician certainty increased in most cases (71 percent), though it decreased in 29 percent.
“Analysis of our findings underscores the value of a number of already appreciated attributes of point-of-care ultrasonography and suggests that its routine use in the septic patient can result in improved clinician confidence, evidence-based changes in management decisions, and a better understanding of the perceived primary cause of vital sign abnormalities.”