Multiorgan Focused Clinical Ultrasonography Does Not Reduce Hospital Stay
Focused clinical ultrasonography (FCU) has been shown to be a reliable and accurate test compared with the imaging reference standard. However, a recent study suggests that integration of multiorgan focused clinical ultrasonography with the initial evaluation does not reduce hospital length of stay by more than 24 hours. The study findings were published in the JAMA Network Open on December 21, 2021.
There are accumulating data about the utility of diagnostic multiorgan focused clinical ultrasonography in the assessment of patients admitted with cardiopulmonary symptoms. However, there is limited information on how FCU affects the clinical decision-making process in the internal medicine setting. Moreover, the information available on the impact of FCU on the hospital length of stay (LOS) is unclear. Therefore, Dr Ximena Cid-Serra and her team conducted a study to determine whether adding multiorgan FCU to the initial clinical evaluation of patients admitted with cardiopulmonary symptoms reduces hospital length of stay, hospital readmissions, and in-hospital costs.
It was a prospective, parallel-group, superiority, randomized study, in which the researchers included 248 patients who were admitted to the internal medicine ward with a cardiopulmonary diagnosis. They compared the heart, lung, and 2-point vein compression FCU in addition (n=124) to standard clinical evaluation (n=124). The major outcome was the difference in the mean length of hospital stay, defined as the number of hours from admission to the internal medicine ward to hospital discharge. They determined a difference of 24 hours as clinically important. The researchers further assessed the hospital readmissions at 30 days and hospital care costs.
Key findings of the study:
- Upon analysis, the researchers noted that the most common initial diagnoses were acute decompensated heart failure reported in 113 patients, pneumonia for 45 patients, and exacerbated chronic pulmonary disease for 32 patients.
- They observed that the length of hospital stay was 113.4 hours in the FCU group and 125.3 hours in the control group.
- They further observed no difference in30-day readmission rate between groups (FCU vs control, 20 of 124 patients [16.1%] vs 15 of 124 patients [12.0%]), nor were total in-hospital costs (FCU vs control, A$7831.1 vs A$7895.7).
The authors concluded, "Adding multiorgan FCU to the initial clinical assessment compared with standard care did not reduce the hospital LOS among patients admitted with cardiopulmonary diagnoses to this internal medicine unit. Although there was a difference of 11.9 hours in the mean hospital LOS between groups, the result was not significant according to the prespecified clinically meaningful difference."
For further information:
DOI:10.1001/jamanetworkopen.2021.38228
