Does Multiorgan FCU Reduce Hospital Stay in Patients With Cardiopulmonary Symptoms?

Multiorgan focused clinical ultrasonography (FCU) assessment for patients admitted to the hospital with cardiopulmonary symptoms did not reduce hospitalization stay by at least 24 hours, according to a study published in JAMA Network Open.

For the clinical trial (Australian New Zealand Clinical Trials Registry Identifier:

ACTRN12618001442291), researchers enrolled patients (N=248) who were admitted to the Royal Melbourne Hospital in Australia with cardiopulmonary conditions between 2018 and 2019. Cardiopulmonary conditions included: acute coronary syndrome, acute decompensated heart failure (ADHF), asthmatic crisis, cardiac valve disease, cardiogenic syncope, exacerbated chronic obstructive pulmonary disease (COPD), interstitial pulmonary disease, pericardial effusion, pleural effusion, pneumonia, pulmonary embolism, or undifferentiated dyspnea. Patients were randomly assigned 1:1 to receive FCU of the heart, lung, and lower extremity (n=124) or usual care (n=124) and were assessed for hospital stay and outcomes.

Patients in the FCU and control cohorts had a mean age of 80.1±11.0 and 79±12.2 years; 54.0% and 43.5% were women; body mass index (BMI) was 29.1±8.1 and 29.3±7.0; and Charlson Comorbidity Index score was 5.47±2.19 and 5.33±1.73, respectively.

Most patients presented at the hospital with shortness of breath (83.4%), and the most common initial diagnosis was ADHF (45.5%) followed by lower respiratory infection or pneumonia (18.1%) and exacerbation of COPD (12.9%).

Among the intervention cohort, the common abnormalities detected by the FCU included left ventricle systolic dysfunction (44.4%), pleural effusion (39.5%), lung collapse (31.5%), and tricuspid regurgitation (28.2%), among others.

The average hospital stay was 113.4 (95% CI, 91.7-135.1) hours among the FCU and 125.3 (95% CI, 101.7-148.8) hours among controls (difference, 11.9 hours; P =.53). A subgroup analysis did not detect any significant effect of the FCU intervention on length of stay.

At 30 days after discharge, 16.1% of the FCU recipients and 12.0% of controls had been readmitted.

No significant healthcare utilization cost differences were observed. The total mean cost of care was A$7831.1 (95% CI, A$5586.1-A$10,076.1) for the FCU and A$7895.7 (95% CI, A$6385.9-A$9405.5) for the usual care recipients (P =.79).

This study may have been biased, as the patient population was older, which may have caused some of the hospitalization time to depend on age and frailty rather than on acute medical condition.

“Adding multiorgan FCU to the initial clinical assessment compared with standard care did not reduce the hospital [length of stay] among patients admitted with cardiopulmonary diagnoses to this internal medicine unit,” the study authors noted. “Although there was a difference of 11.9 hours in the mean hospital [length of stay] between groups, the result was not significant according to the prespecified clinically meaningful difference.”

Reference

Cid-Serra X, Royse A, Canty D, et al. Effect of a multiorgan focused clinical ultrasonography on length of stay in patients admitted with a cardiopulmonary diagnosis: a randomized clinical trial. JAMA Netw Open. 2021;4(12):e2138228. doi:10.1001/jamanetworkopen.2021.38228