title: Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.
abstract: OBJECTIVE
  Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the emergency department (ED) with suspected torso trauma decreased time to operative care.
  
  
  METHODS
  The study was a randomized controlled clinical trial conducted during a 6-month period at 2 Level I trauma centers. The intervention was PLUS conducted by verified clinician sonographers. The primary outcome measure was time from ED arrival to transfer to operative care; secondary outcomes included computed tomography (CT) use, length of stay, complications, and charges. Regression models controlled for confounders and analyzed physician-to-physician variability. All analyses were conducted on an intention-to-treat basis. Results are presented as mean, first-quartile, median, and third-quartile, with multiplicative change and 95% confidence intervals (CIs), or percentage with odds ratio and 95% CIs.
  
  
  RESULTS
  Four hundred forty-four patients with suspected torso trauma were eligible; 136 patients lacked consent, and attending physicians refused enrollment of 46 patients. Two hundred sixty-two patients were enrolled: 135 PLUS patients and 127 controls. There were no important differences between groups. Time to operative care was 64% (48, 76) less for PLUS compared to control patients. PLUS patients underwent fewer CTs (odds ratio 0.16) (0.07, 0.32), spent 27% (1, 46) fewer days in hospital, and had fewer complications (odds ratio 0.16) (0.07, 0.32), and charges were 35% (19, 48) less compared to control.
  
  
  CONCLUSIONS
  A PLUS-inclusive protocol significantly decreased time to operative care in patients with suspected torso trauma, with improved resource use and lower charges.
authors.affiliation: Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215-9008, USA. lam9004@nyp.org
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Melniker
authors.forename: Evan
authors.initials: E
authors.lastname: Leibner
authors.forename: Mark G
authors.initials: MG
authors.lastname: McKenney
authors.forename: Peter
authors.initials: P
authors.lastname: Lopez
authors.forename: William M
authors.initials: WM
authors.lastname: Briggs
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems; D013997:Time Factors; D014463:Ultrasonography; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000191:economics / Q000601:surgery