Enhanced Diagnostic Precision in Revisited Emergency Patients via Point-of-Care Ultrasound: A Tool for Emergency Department Quality Management

Kamonwon Ienghong,1 Sukanya Khemtong,1 Lap Woon Cheung,2,3 Korakot Apiratwarakul1 1Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Accident & Emergency Department, Princess Margaret Hospital, Kowloon, Hong Kong; 3Department of Emergency Medicine, Li ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong KongCorrespondence: Korakot Apiratwarakul, Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Road, Mueang Khon Kaen District, Khon Kaen, 40002, Thailand, Tel +66 89 416 3663, Fax +66 43 366 870, Email [email protected]: Unscheduled return visits to the emergency department (ED) were categorized into physician-related, illness-related, and patient-related factors, which are associated with an increased risk of adverse health outcomes, including patient dissatisfaction, infections, hospitalization, transfer to another facility, and mortality. Individuals within 48– 72 hours of the initial visit are deemed at elevated risk for diagnostic or management-related errors. The Point-of-care ultrasound (POCUS) may serve as a bedside tool to reduce medical errors by enhancing diagnostic precision. This study aims to determine the diagnostic accuracy of POCUS for detecting various illnesses in revisited patients in the emergency department.Patients and Methods: A retrospective observational study was conducted on unplanned revisits by patients to the emergency department within 72 hours, spanning the period from January 2023 to September 2024. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were evaluated based on electronic emergency department medical records and ultrasound documentation.Results: Five hundred seventy patients were included in this study. POCUS demonstrated a diagnostic accuracy of 75.61% (95% CI 71.87, 79.09), a sensitivity of 81.87% (95% CI 77.65, 85.58), a specificity of 62.50% (95% CI 55.08, 69.51), a positive likelihood ratio of 2.18 (95% CI 1.80, 2.65), and a negative likelihood ratio of 0.29 (95% CI 0.23, 0.37).Conclusion: POCUS demonstrated greater diagnostic accuracy, which may enhance diagnostic precision in revisited patients with various illnesses.Keywords: precision medicine, ultrasound, revisit, emergency department, quality