Pocus Triage in Patients Presenting to the Emergency Department with Abdominal Pain

Comparison of the Effectiveness of Focused Point-of-Care Ultrasonography Triage and Classical Triage in Patients Applying to the Emergency Department with Abdominal Pain

Introduction and Objective: This study aimed to reveal the effect of classical triage and Bedside Focused Ultrasonography (POCUS) in addition to classical triage on diagnosis, treatment, emergency department follow-up and its relationship with triage models in patients presenting to the emergency department with abdominal pain complaints.

METHOD: This randomized, controlled, prospective study was conducted with a total of 262 volunteer participants who were divided into two groups as 127 classical triage and 135 POCUS in addition to classical triage with non-traumatic abdominal pain. The decision of which participant would be included in which group was made at a 1:1 ratio using a computer-aided randomization table. The researcher did not intervene in the clinical processes in any way. In this study, the effect of POCUS application performed in addition to classical triage on clinical processes (imaging request, initial analgesia administration time, consultation request, emergency department stay and outcome) in the primary outcome and on triage systems in the secondary outcome were evaluated. IBM SPSS 21.0 software was used for statistical analysis of the data.

Study Overview

• Status: Completed
• Conditions: Triage; Point of Care Ultrasound (POCUS); Abdominal Pain (AP)
• Intervention / Treatment: Other: Point of care ultrasound (POCUS)

• Study Type: Interventional
• Enrollment (Actual): 262
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Adapazarı
    • Sakarya, Adapazarı, Turkey, 54100
      • Sakarya Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Present to the emergency room with abdominal pain
• No history of trauma in the last 48 hours
• Stable hemodynamics

Exclusion Criteria:

• According to the 3-way triage, the color code is red
• Being under the age of 18
• Being pregnant
• Having a history of trauma within the last 48 hours
• Being morbidly obese
• Having mental retardation
• Having repeated emergency room visits
• Being referred from the polyclinic to the emergency room with a diagnosis
• Filling the study form incompletely

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: POCUS Triage; Patients are directed to the area where they will be examined in accordance with the triage category determined by abdominal POCUS, which is performed in addition to classical triage.	Other: Point of care ultrasound (POCUS); In this study, POCUS was performed by the same emergency medicine physician who had basic and advanced USG training and at least two years of POCUS experience, in accordance with ACEP imaging protocols. A portable USG device with B-Mode, M-Mode, Color Doppler, Power Doppler, Pulsed Wave Doppler modes, and which can be used in all clinical modes with a single probe was used during the protocol application (Butterfly iQ+™, Burlington, United States). Eight abdominal points (epigastric region, right upper quadrant, right side, right lower quadrant, suprapubic region, left lower quadrant, left side and upper quadrant, umbilical region) were scanned with POCUS, the findings were recorded on the previously prepared form, the triage categories of the patients (cl) were updated and the patients were directed to the area where they would be examined with the form.
No Intervention: Classical Triage; Patients are directed to the area where they will be examined in accordance with the triage category determined by classical triage application.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to initial analgesia	To evaluate the effect of adding the POCUS application to conventional triage on clinical processes, including imaging requests, time to initial analgesia.	6 months
Request for additional medical imaging	To evaluate the effect of adding the POCUS application to conventional triage on imaging requests.	6 months
Emergency department length of stay	To evaluate the effect of adding POCUS to conventional triage on the length of stay of patients in the emergency department.	6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
POCUS diagnostic sensitivity	To determine the diagnostic sensitivity of POCUS performed during triage using the final reports of patients who requested imaging.	6 months
Emergency severity index Outcome Measure	To examine the categorization changes after POCUS with the emergency severity index before POCUS application.	6 months
Manchester Triage System Outcome Measure	To examine the categorization changes after POCUS with Manchester triage system before POCUS application.	6 months
3-group triage system Outcome Measure	To examine the categorization changes after POCUS with 3-group triage system before POCUS application	6 months

Collaborators and Investigators

• Sponsor: Sakarya University

Publications and helpful links

General Publications

• Guner NG, Yurumez Y, Yucel M, Alacam M, Guner ST, Ercan B. Effects of Point-of-care Ultrasonography on the Diagnostic Process of Patients Admitted to the Emergency Department with Chest Pain: A Randomised Controlled Trial. J Coll Physicians Surg Pak. 2020 Dec;30(12):1262-1268. doi: 10.29271/jcpsp.2020.12.1262.
• Thamburaj R, Sivitz A. Does the use of bedside pelvic ultrasound decrease length of stay in the emergency department? Pediatr Emerg Care. 2013 Jan;29(1):67-70. doi: 10.1097/PEC.0b013e31827b53f9.
• Durgun Y, Yurumez Y, Guner NG, Aslan N, Durmus E, Kahraman Y. Abdominal Pain Management and Point-of-care Ultrasound in the Emergency Department: A Randomised, Prospective, Controlled Study. J Coll Physicians Surg Pak. 2022 Oct;32(10):1260-1265. doi: 10.29271/jcpsp.2022.10.1260.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2024
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): June 30, 2024

Study Registration Dates

• First Submitted: February 28, 2025
• First Submitted That Met QC Criteria: March 18, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 18, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Triage; Emergency department; Abdominal pain; POCUS
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathologic Processes; Disease Attributes; Signs and Symptoms, Digestive; Abdominal Pain; Emergencies
• Other Study ID Numbers: 16214662-050.01.04-319685-197

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No