The effect of bedside point of care ultrasound on the diagnosis and treatment process of patients presenting to the emergency department with chest pain

Objectives: Chest pain is one of the most common reasons for admission to the emergency department. The aim of this study was to investigate the effect of emergency bedside point of care ultrasonography during the initial evaluation of patients presenting to the emergency department with the complaint of chest pain on the diagnostic process, emergency department length of stay and costs. Methods: In a prospective, parallel-group trial in the emergency department at Sakarya University Training and Research Hospital, Turkey, patients (≥18 years) with a chest pain, no history of trauma within the last 24 hours, non-pregnant, no need for urgent angiography with ST elevation myocaridial infarct, without permanent mental disorder were randomly assigned in a 1:1 ratio to a standard diagnostic strategy (control group) or to standard diagnostic strategy supplemented with point-of-care ultrasonography ( emergency bedside point-of-care ultrasonography group). In the light of the data obtained from the study, the effect of bedside poin of care ultrasonography during the initial evaluation of the patients on the diagnostic process, emergency department length of stay and average costs was analyzed. Results: Participating in the study 208 patients were randomized in a 1: 1 ratio and analyzed as control group (n=104) and emergency bedside point of care ultrasonography group (n=104). The mean age of 208 patients was 50.42 (min: 18-max: 89) and 53.8% were male. The most common comorbities were hypertension (33.5%), diabetes mellitus (17.8%) and coronary artery disease (13%), respectively. Dyspnea was the most common accompanying symptom (%25,4). Emergency bedside ultrasonography in patients presenting with chest pain had a statistically significant change in the number of preliminary diagnoses, which had a positive effect on the diagnostic process by reducing the differential diagnosis range. (p<0,01) Non-ST elevation myocardial infarction and myalgia were the most common presumed diagnoses in patients admitted to the emergency department, and bedside ultrasonography aimed at the immediate target, especially in both presumed patients, significantly reduced the length of stay in the emergency department. (p<0,05) Detection of pathology in the emergency bedside poin of care ultrasonography increased the rate of hospitalization. In addition, bedside point of care ultrasound significantly shortened the duration of the emergency department length of stay in patients who were discharged.The Emergency department length of stay for the bedside point of care ultrasonography (202.96 minutes) was significantly shorter than control group (254.92 minutes, p<0.05). Although the average costs were also reduced, the difference was not statistically significant. (p>0,05) Conclusion: The practice of bedside ultrasound, which is a reproducible, non-irradiated, practical imaging method performed by emergency department physicians, contributes to the diagnosis process positively by decreasing the preliminary diagnoses and decreases the duration of emergency room stay and costs. In addition, if pathological findings are detected on bedside ultrasonography for emergency targets, the rate of hospitalization increases. However, further studies are needed to determine whether it should be useful in routine practice in the emergency department. Key words: emergency department, chest pain, point-of-care ultrasound, length of stay, cost