Schoorlemmer, L. (Luuk) (2014) RUSH-spoedecho bij opvang van patiënten met tekenen van ongedifferentieerde shock op de spoedeisende hulp. thesis, Medicine.
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Abstract
Background: Undifferentiated shock is a clinical condition with a high mortality rate. It is a commonly seen condition in the emergency department. Early recognition and intervention leads to a lower mortality rate. Goal-directed ultrasound is a fast and non-invasive technique that can provide useful information about the etiology of shock. The purpose of this study was to examine the effect of a goal-directed ultrasound protocol called the RUSH exam on the accuracy of the diagnostic procedure in patients with undifferentiated shock in the emergency department. The hypothesis was that the RUSH exam would lead to less diagnoses in the differential diagnosis, increased certainty of the physician on the diagnosis and more correct diagnoses. Methods: Thirty six adult patients were prospectively enrolled, presenting with signs of undifferentiated shock upon arrival at the emergency department. Patients were randomly assigned to receive either standard care or standard care followed by a RUSH exam. The RUSH exam was used to determine cardiac function, right/left ventricle diameter rate, inferior vena cava diameter and collapsibility, identify a pneumothorax or pulmonary oedema, abdominal free fluid, aortic aneurysm and deep venous thrombosis. Outcomes included the number of diagnoses in the differential diagnosis, the certainty of the physician on the diagnosis and whether the diagnosis matches the final clinical diagnosis. Certainty of the physician was scored on a 1 to 7 Likert scale, ranging from very uncertain to very certain. The scores were obtained after physical examination, after the RUSH exam and after ancillary investigations. Results: No significant differences were found between the two groups in accuracy of the differential diagnostic procedure. However, after performing a RUSH exam a decrease in number of diagnoses in the differential diagnosis (Mean (M) = 3.22, 95% Confedence Interval (CI) = 2.53 - 3.92) vs. (M = 2.94, 95% CI = 2.32 – 3.57) and a higher certainty of the physician about the diagnosis (M = 5.17, 95% CI = 4.78 – 5.56) vs. (M = 5.78, 95% CI = 5.45 – 6.10) were found compared to the scores after physical examination. Furthermore, 72,2% of the physicians found the exam in some way of added value in patient care, in the group of patients receiving a RUSH exam. Conclusions: The results of this study do not support the hypothesis of a more accurate diagnostic procedure in patients with undifferentiated shock after performing a RUSH exam. However, considering the small sample size of this study, the results show a possible effect of the RUSH exam on the accuracy of the differential diagnostic procedure. Further research is needed to examine this effect and other positive effects of the RUSH exam on patient care.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Maaten, J.C. ter and Doff - Holman, M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1040 |
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