Shunichiro Nakao

Years since first academic appointment: Less than 5 years

Title: Evaluation of the Impact of Point-of-Care Ultrasonography on Patients Suspected of Having Acute Exacerbation of Chronic Obstructive Pulmonary Disease or Heart Failure in the Emergency Department

Authors: Shunichiro Nakao, MD, Christian Vaillancourt, MD, MSc, FRCPC, CSPQ, Monica Taljaard, PhD, Ian G. Stiell, MD, MSc, FRCPC, Michael Y. Woo, MD, CCFP-EM, RDMS

Background: Acute exacerbations of chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common causes of shortness of breath (SOB), and are often not easy to differentiate in the emergency department (ED).

Objective: The general objective is to determine the clinical impact of Point-of-Care Ultrasonography (POCUS) on patient-oriented outcomes relevant to patients, ED physicians, and administrators. Specifically, we intend to measure the impact of POCUS on 1) length-of-stay (LOS) in the ED and 2) time to appropriate treatment, 3) to determine test characteristics compared to gold standard and 4) the impact on unexpected visits to the ED within 7 days, and 5) to develop a clinical decision rule incorporating POCUS.

Methods: This will be a prospective observational cohort study at The Ottawa Hospital, tertiary care facilities in Ottawa, Canada. We will include patients with SOB secondary to suspected acute exacerbation of COPD or HF. POCUS will be performed or not based on ED physician’s usual practice. Diagnostic gold standard will be determined by committee consensus based on a health record review. We will analyze time to event using survival analysis, test characteristics reporting sensitivity, specificity, positive predictive value and negative predictive value with 95% confidence interval, and chi-square and multivariate logistic regression analysis to study unexpected return visits, and univariate and recursive partitioning analyses for decision rule.