Many medical specialties and paramedical fields are increasingly using point-of-care ultrasound (PoCUS). In daily practice, thoracic and abdominal pain constitute a significant portion of emergency department consultations. PoCUS can be employed in various ways during thoracic and abdominal physical examinations. Most scientific societies advocate for its use to address specific clinical questions rather than to provide a definitive diagnosis.
The integration of PoCUS into clinical examinations raises the question of its effectiveness in improving the diagnostic approach, rather than its diagnostic accuracy alone. Given the broad spectrum of differential diagnoses for thoracic and abdominal pain, this multicenter prospective study protocol aims to evaluate how PoCUS enhances the diagnostic approach for patients presenting with these symptoms in the emergency department.
To assess the contribution of PoCUS, three members of an adjudication committee will blindly choose between two case report forms reporting the planned diagnostic approach for each patient: one completed before PoCUS and the other after its use by the investigator handling the case. The hypothesis that PoCUS improves the diagnostic approach by 60% will be reached if 60% of the improved diagnostic approaches favor the case report form filled out after PoCUS.
> 17 years
Thoracic or abdominal pain for less than 72 hours
Signed informed consent
Reasons making abdominal ultrasound impossible
Discovery of a pregnancy during emergency care
Follow-up impossible at one month
Single group
Point of care ultrasound
Diagnostic testThe investigator uses PoCUS to investigate thoracic or abdominal pain after anamnesis and clinical examination. The investigator reports the anamnesis, clinical examination, and PoCUS results in the patient's medical file. PoCUS images are recorded according to the procedures of the study centers and the capacities of the ultrasound machines.
Percentage of superior diagnostic approaches post-PoCUS.
Percentage of superior diagnostic approaches post-PoCUS. For each patient included in the final analysis and based on the final diagnosis determined at the 1-month follow-up, three independent members of an adjudication committee will evaluate the two diagnostic approaches (pre-PoCUS and post-PoCUS) recorded in the case report forms (CRFs). The adjudication committee members will remain blinded to the intervention, ensuring they are unaware of whether the diagnostic approach occurred before or after PoCUS. For each patient, the committee, knowing the final diagnosis, will assess and determine which diagnostic approach is superior or if the two approaches are equivalent.
PoCUS influence on the number of diagnoses in the differential diagnosis, on the number of treatments and on the number of complementary examination(s)
Absolute number before and after PoCUS
PoCUS influence on the physicians' coefficient of certainty regarding the diagnostic approach
Evaluation of % of certainty coefficient before and after PoCUS
PoCUS influence on the physicians' coefficient of certainty regarding the final diagnosis if this diagnosis is part of the differential diagnosis established bedside
Evaluation of % of certainty coefficient before and after PoCUS
PoCUS usefulness evaluated by the physician in charge
Number of PoCUS considered not useful, useful, very useful
Click on the lead sponsor to view all of their trials.
