SHoC-ED
Trial question
What is the role of point-of-care ultrasonography protocol in emergency department patients with undifferentiated hypotension?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
49.0% female
51.0% male
N = 273
273 patients (135 female, 138 male)
Inclusion criteria: patients who presented to the emergency department with undifferentiated nontraumatic hypotension or shock
Key exclusion criteria: pregnancy, necessity of CPR or other advanced cardiac life support interventions before enrollment, history of significant trauma in the past 24 hours, clear mechanism of shock
Interventions
N=138 point-of-care ultrasonography (early point-of-care ultrasonography scans plus standard care)
N=135 control (usual care without any point-of-care ultrasonography)
Primary outcome
Rate of survival to 30 days or hospital discharge
76.5
76.1
76.5 %
57.4 %
38.3 %
19.1 %
0.0 %
Point-of-care
ultrasonography
Control
No significant
difference ↔
No significant difference in the rate of survival to 30 days or hospital discharge (76.5% vs. 76.1%; AD 0.35%, 95% CI -10.2 to 11)
Secondary outcomes
No significant difference in intravenous fluid administration (1609 mL vs. 1683 mL; AD 74 mL, 95% CI -50.8 to 196.2)
No significant difference in hospital length of stay (9.59 days vs. 9.71 days; AD 0.12 days, 95% CI -1.74 to 2.36)
No significant difference in ICU length of stay (7.16 days vs. 5.14 days; AD 2.018 days, 95% CI -0.85 to 4.63)
Safety outcomes
No significant difference in rates of CT scanning and rates of inotrope administration.
Conclusion
In patients who presented to the emergency department with undifferentiated nontraumatic hypotension or shock, point-of-care ultrasonography was not superior to control with respect to the rate of survival to 30 days or hospital discharge.
Reference
Paul R Atkinson, James Milne, Laura Diegelmann et al. Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Ann Emerg Med. 2018 Oct;72(4):478-489.
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