Short summary

The aim of this study is to examine to what degree point-of-care ultrasound of heart, lungs, abdominal organs, and of the deep venous system can assist clinical decision making in relation to treatment and diagnosis among an acutely admitted cohort of geriatric patients, and secondly to compare the accuracy of handheld ultrasound devices to a stationary ultrasound scanner.

Rationale

Point-of-care ultrasound (POCUS) has gained popularity in many medical specialties worldwide, especially in intensive care units (ICUs) and emergency departments (EDs). In the hands of an experienced clinician, POCUS is regarded as a valid, safe, and reliable method for obtaining bedside diagnostics and for procedural guidance. With the advantages of POCUS as a bedside and patient-near examination tool performed by attending and qualified physician, it seems to be a perfect fit for examining geriatric patients. Vague symptoms of acute disease is frequently seen in geriatric patients due to the ageing-related alteration in physiology, e.g. fever is a less prominent symptom despite fulminant infection. Furthermore, geriatric patients are victims of age, multimorbidity, functional decline, and polypharmacy that arekey elements of the frailty syndrome, making them vulnerable when exposed to numerous diagnostic testing at various departments during hospitalisation. Hence, entails diagnostic challenges, and inappropriate and potentially delayed treatment. Given the multiple validated and standardised ultrasound protocols for examination of different organs (heart, lung, liver, kidney etc.) POCUS can help the attending physician in the diagnostic process when treating frail geriatric patients. Previous studies conducted in the emergency departments show that POCUS have potential clinical impact in diagnosing both unselected ED patients, patients with acute respiratory distress, community acquired pneumonia, and other life threatening conditions.

Due to the variety of acute conditions affecting heart, lung, abdominal organs, and the deep venous system, use of ultrasound for screening these organs in geriatric patients with vague and atypical symptoms should be examined further. However, almost no studies exist on acute geriatric patients, except for Ticinesi et al who found that focused lung ultrasound to have better diagnostic accuracy than standard chest x-ray for diagnosing pneumonia in acutely admitted geriatric patients, especially in frail individuals. Even so, to our knowledge, no studies have examined whether focused POCUS can change tentative diagnoses in acutely admitted geriatric patients or induce a change in the path of hospitalization. A narrative review by Frölich et al found that sonographic measurements may not differ significantly compared to younger adults, although comparative studies lack. Several handheld ultrasound devices have emerged as a useful supplement to the traditional stationary ultrasound device. One study carried out on a geriatric inpatient population, found a near identical accuracy compared to a high-end stationary device for examining patients with dyspnea, falls and fever, when using a dichotomous approach.

The primary objective of this study is to explore to what degree POCUS of heart, lungs, abdominal organs, and of the deep venous system can alter tentative diagnosis and assist clinical decision making in relation to treatment and diagnosis among an acutely admitted cohort of geriatric patients.

The secondary objective of this study is to investigate the diagnostic ability of hand-held ultrasound scanners compared to stationary ultrasound scanner.

Description of the cohort

The study is conducted at the Geriatric Department at Odense University Hospital, Odense. The department is a highly specialized medical department with geriatric specialist consultants and specialty doctors caring for 27 in-hospital beds and a large out-patient clinic with about 1600 out-patients. In 2020, 1798 unique patients (mean age 83 years, mean length of stay 6.2 days, males 50 %) were discharged from the geriatric wards.

The vast majority of patients is admitted acutely (99,5 %) through the acute medical unit (AMU), where patients with an expected short term hospital stay (< 48 hours) are discharged from the AMU, while more severely ill and complex geriatric patients are transferred to the geriatric department.

Patients admitted at the Geriatric Department at Odense University Hospital (OUH) are eligible to participate in the study. Patients with cognitive impairment including delirium are xcluded from the study due to Danish legislation and recommendations from the Regional Committees on Health Research Ethics for Southern Denmark.

Data and biological material

Data from the patient journal will be collected to calculated the Charlson Comorbidity Index. Questionnaires from ward attending doctors and questionnaires from POCUS-operators is used to collect data for the primary and secondary outcomes. No biological material will be collected in this study.

Collaborating researchers and departments

Department of Respiratory Diseases, Odense University hospital

• Professor Christian B. Laursen
• Casper Falster, MD, PhD-student