The Need for SPEED: Sonography for Pulmonary Embolism in the Emergency Department.
The Journal of emergency medicine · 2025-03-26 · Observational study
Abstract
BACKGROUND: Pulmonary embolism (PE) is difficult to diagnose and has high morbidity and mortality. OBJECTIVE: The aim of this study was to compare time to computed tomography (CT) order, time to CT acquisition, and time to anticoagulant administration in patients with PE who received point-of-care ultrasound (POCUS) vs. no POCUS. METHODS: Retrospective study at an academic level I trauma center in South Carolina from 7/1/2019-6/30/2022 and included adults 18 years and older who received a PE diagnosis in the emergency department (ED). Outcomes evaluated included times to specific CT metrics and time to anticoagulant administration. Times were measured from the time the patient either arrived at the ED triage desk or arrived via emergency medical services to the time the outcome occurred. Results were compiled using χ2 and t-tests. Quantile regression was used to assess the differences in median times to CT order, CT acquisition, and anticoagulant administration by POCUS status. RESULTS: Of 452 eligible patients, 73 (16.2%) received POCUS in the ED with a median time to receiving POCUS of 100 min (interquartile range 172 min). Patients who received POCUS had a chest CT ordered 27 min sooner (p = 0.0097) and performed 21.0 min sooner (p = 0.1018) compared with patients who did not receive POCUS. Five of every 6 patients (83.4%) received anticoagulation with a median time to anticoagulant administration of 289 min (interquartile range 182 min). Those who were evaluated with POCUS received anticoagulation 49 min sooner than those who were not evaluated with POCUS (p = 0.0235). CONCLUSIONS: Use of POCUS was associated with a shorter time to CT order and time to anticoagulant administration. Future prospective studies are needed to assess the relationship of POCUS to time to diagnosis and treatment of PE.