- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03532165
Use of Bedside Ultrasound in Emergency Department Patients With Concern for Pulmonary Embolism to Reduce CT Imaging
Study Overview
Status
Intervention / Treatment
Detailed Description
In this study, the subgroup of hemodynamically stable patients felt to be at moderate to high risk for PE will receive a bilateral LCUS before possible CTA/VQ imaging. The LCUS of the entire proximal leg including the popliteal fossa will be performed by an emergency medicine resident provider in conjunction with their attending. All positive studies will then be confirmed with a second ultrasound by the Albany Medical Center's vascular laboratory service. Patients with confirmed acute positive studies identifying a DVT will be treated for a presumed PE, which is the same treatment as that for the DVT. No CTA will be ordered from the ED. They will be anticoagulated and admitted to the hospital, with further management as per the inpatient hospital team. Patients with a negative emergency department LCUS done by the resident will receive either a CTA or a VQ (ventilation/perfusion) scan as per the initial treatment plan established by the attending physician.
According to this protocol, patients discharged home by default must have had a negative CTA or VQ scan, and so PE was effectively ruled out. Therefore they will not require further follow up after discharge. However, we will follow patients who were admitted throughout their admission course. Through review of medical records, we will take note of any complications such as any issues with starting anticoagulation treatment without a CTA, misdiagnoses, whether a CTA was ordered later as a part of their course and why, and further details.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Dorcas B Pinto, MD
- Phone Number: 518-262-3773
- Email: PintoD@amc.edu
Study Contact Backup
- Name: Beth Cadigan, MD
- Phone Number: 518-262-3773
- Email: CadigaB@amc.edu
Study Locations
-
-
New York
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Albany, New York, United States, 12208
- Recruiting
- Albany Medical Center Department of Emergency Medicine
-
Contact:
- Dorcas B Pinto, MD
- Phone Number: 518-262-3773
- Email: PintoD@amc.edu
-
Contact:
- Beth Cadigan, MD
- Phone Number: 518-262-3773
- Email: CadigaB@amc.edu
-
Principal Investigator:
- Dorcas B Pinto, MD
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Principal Investigator:
- Beth Cadigan, MD
-
Sub-Investigator:
- Sean Donovan, MBCHB
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Clinical Concern for PE (moderate to high risk) that warrants imaging of the chest
Exclusion Criteria:
- Age less than 18
- nidus for DVT in upper extremity (eg. PICC (peripherally inserted central Cather) line, etc)
- already anti-coagulated at presentation
- above the knee- leg cast
- prisoners
- DVT ultrasound or CTA prior to presentation
- Hemodynamically unstable:
- SBP (systolic blood pressure) <90 for >15min
- Drop of SBP by at least 40mmHG for >15mins
- Organ hypoperfusion (eg cold extremities, mental confusion, low urine outpt <30cc/hr, etc
- need for pressors
- Other concerns in thorax necessitating inevitable CT chest imaging.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: DIAGNOSTIC
- Allocation: RANDOMIZED
- Interventional Model: SEQUENTIAL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Positive lower extremity ultrasound
This group found to to have a deep venous thrombosis on lower extremity ultrasound will not have a CT of the chest ordered from the emergency department, and will be treated for the DVT and presumed PE.
|
One group may forego a CT angiogram of the chest if they have a positive lower extremity ultrasound.
The other group with a negative ultrasound may still require CT angiogram imaging.
Other Names:
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Other: Negative lower extremity ultrasound
This group that does not have a deep venous thrombosis on lower extremity ultrasound will proceed to get the CT of the chest .
|
One group may forego a CT angiogram of the chest if they have a positive lower extremity ultrasound.
The other group with a negative ultrasound may still require CT angiogram imaging.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Absolute reduction in CT imaging to diagnose PE
Time Frame: for duration of the study,about 1 year
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With the use of lower extremity ultrasound to diagnose DVT, some patients may forego the need for CT imaging while receiving appropriate care/treatment.
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for duration of the study,about 1 year
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Potential reduction in CT imaging to diagnose PE
Time Frame: for duration of the study, about 1 year
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If a CT is ordered on a patient with a positive lower extremity ultrasound by an inpatient physician later during the admission, we will calculate what the reduction in CT imaging would have been if the protocol had been followed to the end.
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for duration of the study, about 1 year
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Time to start of treatment
Time Frame: for duration of the study , about 1 year
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The use of bedside ultrasound may allow for making a diagnoses more quickly, and therefore potentially starting treatment sooner.
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for duration of the study , about 1 year
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Cost-analysis
Time Frame: for duration of study, about 1 year
|
The use of ultrasound may have less cost than using a CT scan
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for duration of study, about 1 year
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Dorcas B Pinto, MD, Albany Medical College
Publications and helpful links
General Publications
- Skinner S. Pulmonary embolism: assessment and imaging. Aust Fam Physician. 2013 Sep;42(9):628-32.
- Da Costa Rodrigues J, Alzuphar S, Combescure C, Le Gal G, Perrier A. Diagnostic characteristics of lower limb venous compression ultrasonography in suspected pulmonary embolism: a meta-analysis. J Thromb Haemost. 2016 Sep;14(9):1765-72. doi: 10.1111/jth.13407. Epub 2016 Aug 17.
- Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, Leftheriotis G, Barghouth G, Cornuz J, Hayoz D, Bounameaux H. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004 Mar 1;116(5):291-9. doi: 10.1016/j.amjmed.2003.09.041.
- Poley RA, Newbigging JL, Sivilotti ML. Estimated effect of an integrated approach to suspected deep venous thrombosis using limited-compression ultrasound. Acad Emerg Med. 2014 Sep;21(9):971-80. doi: 10.1111/acem.12459.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 4975
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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