Role of early point of care ultrasound in management of sepsis in emergency department: A randomized clinical trial

Abstract

Background: Sepsis is a highly fatal condition. Early diagnosis and prompt management are crucial to improve outcomes. Point-of-care ultrasound (POCUS) has been used recently in different presentations in the emergency department (ED). Aim of this study was to compare the POCUS group and the clinical group regarding accuracy and time to reach a final diagnosis. Methods: Two hundred patients with suspected sepsis or septic shock were enrolled and randomized into two groups, each included 100 patients. The clinical group was managed by history taking and physical examination, and the POCUS group was managed by adding POCUS to the history taking and clinical evaluation. Diagnoses of both groups were compared to the final diagnosis. The primary outcome was to compare both groups regarding the accuracy of diagnosis, and the secondary outcome was to determine the time to reach the final diagnosis. Results: Accuracy of POCUS diagnosis in chest infection, intraabdominal sepsis, urosepsis and infective endocarditis was 90.00 (%95%CI (82.38% to 95.10%)), 96.00 % with 95%CI (90.07% to 98.90%), 93.00 % with 95%CI(86.11% to 97.14%), and 100.00 % with 95%CI(96.38% to 100.00%) respectively while for clinical group it was 96.00% with 95% CI (90.07% to 98.90%), 99.00% with 95%CI (94.55% to 99.97%), 98.00% with 95%CI (92.96% to 99.76%) and 100.00% with 95% CI (96.38% to 100.00%) respectively, time to reach a final diagnosis was longer in the clinical group (p=.010).Conclusion: In patients with sepsis, point-of-care ultrasound decreased time to diagnosis but was not more accurate than clinical evaluation.