| Intervention group (n = 106) n (%; 95% CI) | Control group (n = 105) n (%; 95% CI) | P value | Absolute effect % (95% CI) | Relative effect (95% CI) |
---|---|---|---|---|---|
PRIMARY ENDPOINT | |||||
 4 h after admission to the ED | |||||
  Proportion of patients with presumptive diagnoses in agreement with final diagnoses | 84 (79.3%; 70.3–86.0) | 81 (77.1%; 68.0–84.3) | 0.71 | 2.1% (−9.0–13.2) | 1.03(0.89–1.18) |
SECONDARY ENDPOINTS | |||||
 4 h after admission to the ED | |||||
  Proportion of patients with appropriate treatment ordered a | 84 (79.3%; 70.3–86.0) | 69 (65.7%; 56.0–74.3) | 0.03 | 13.5% (1.6–25.5) | 1.21 (1.02–1.43) |
 After primary assessment in the ED | |||||
  Proportion of patients with presumptive diagnoses in agreement with final diagnoses | 65 (61.3%; 51.6–70.2) | 65 (61.9%; 52.1–70.8) | 0.93 | −0.5% (−13.7–12.5) | 0.99(0.80–1.23) |
 Specific treatment prescribed within 4 h from admission to the ED | |||||
  Oxygen | 33 (31.1%; 22.5–40.0) | 37 (35.2%; 26. 2–45.2) | 0.53 | −4.1% (−16.8–8.6) | 0.88 (0.60–1.30) |
  NIV/CPAP | 3 (2.80%; 0.9–8.4) | 0 (0%; 0–3.5¥) | 0.08 | 2.8% (−0.3–6.0) | – |
  Respirator | 0 (0%; 0–3.4¥) | 0 (0%; 0–3.5¥) | – | 0 | – |
  Bronchodilators | 26 (24.5%; 16.5–34.0) | 20 (19.1%; 12.0–27.9) | 0.34 | 5.5% (−5.6–16.6) | 1.29 (0.77–2.16) |
  Systemic steroids | 24 (22.6%; 14.9–31.9) | 21 (20.0%; 12.8–28.9) | 0.64 | 2.6% (−8.4–13.7) | 1.13 (0.67–1.90) |
  Antibiotics | 30 (28.3%; 19.9–38.2) | 38 (36.2%; 27.0–46.1) | 0.22 | −7.9% (−20.5–4.7) | 0.78 (0.53–1.16) |
  Fluids i.v. | 15 (14.2%; 7.7–22.0) | 25 (23.8%; 16.0–33.1) | 0.07 | −9.7% (− 20.2–0.8) | 0.59 (0.33–1.06) |
  Diuretics | 13 (12.3%; 7.0–20.8) | 12 (11.4%; 6.0–19.1) | 0.85 | 0.8% (−7.9–9.6) | 1.07 (0.51–2.24) |
  Antiarrythmics | 4 (3.8%; 1.1–9.7) | 3 (2.9%; 0.6–8.1) | 0.71 | 0.9% (−3.9–5.7) | 1.32 (0.30–5.76) |
  Vasoconstrictors | 0 (0%; 0–3.4¥) | 0 (0%; 0–3.5¥) | – | 0 | – |
  Anticoagulants | 10 (9.4%; 4.8–17-3) | 13 (12.4%; 6.8–20.2) | 0.49 | −2.9% (−11.4–5.5) | 0.76 (0.35–1.66) |
  Therapeutic centesis b | 3 (2.8%; 0.6–8.4) | 3 (2.9%; 0.6–8.1) | 0.99 | −0.0% (−4.5–4.5) | 0.99 (0.20–4.80) |
  Others | 8 (7.6%; 3.4–14.9) | 6 (5.7%; 2.1–12.0) | 0.59 | 1.8 (−4.9–8.5) | 1.32 (0.47–3.68) |
 Supplementary diagnostic tests ordered within 4 h from admission to the ED | |||||
  Ultrasound of the lungs c | 34 (32.1%; 23.3–41.8) | 10 (9.5%; 4.7–16.8) | 0.0001 | 22.6% (12.0–33.1) | 3.37 (1.76–6.46) |
  X-ray of the thorax | 85 (80.2%; 71.3—87.2) | 90 (85.7%; 77.5–91.8) | 0.29 | −5.5% (−15.6–4.6) | 0.94 (0.83–1.06) |
  CT of the thorax | 10 (9.4%; 4.6–16.7) | 9 (8.6%; 4.0–15.6) | 0.83 | 0.9% (−6.9–8.6) | 1.10 (0.47–2.60) |
  MR of the thorax | 0 (0%; 0–3.4¥) | 0 (0%; 0–3.5¥) | – | 0 | – |
  Diagnostic centesisb | 1 (0.9%; 0.0–5.1) | 2 (1.9%; 2.3–6.7) | 0.56 | −1.0% (−4.2–2.2) | 0.50 (0.05–5.58) |
  Echocardiography by cardiologist | 15 (14.2.%; 8.1–22.3) | 19 (18.1%; 11.3–26.8) | 0.44 | −3.9% (−13.9–6.0) | 0.78 (0.42–1.45) |
  Ultrasound of the deep veins d | 2 (1.90%; 0.2–6.6) | 0 (0%; 0–3.5¥) | 0.16 | 1.9% (−0.7–4.5) | – |
  Other diagnostic tests | 24 (22.6%; 15.1–31.8) | 12 (11.4%; 6.0–19.1) | 0.02 | 11.2% (1.2–21.2) | 1.98 (1.05–3.75) |
 Time spent in the ED (hours) | |||||
   < 1 | 24 (22.6%; 15.6–31.7) | 28 (26.7%; 19.0–36.1) | 0.50 | −4.0% (−15.6–7.6) | 0.85 (0.53–1.36) |
  1–2 | 20 (18.9%; 12.4–27.6) | 24 (22.9%; 15.7–32.0) | 0.48 | −4.0% (−14.9–7.0) | 0.83 (0.49–1.40) |
  3–4 | 23 (21.7%; 14.8–30.7) | 18 (17.1%; 11.0–25.7) | 0.40 | 4.6% (−6.1–15.2) | 1.3 (0.73–2.20) |
  5–8 | 15 (14.2%; 8.6–22.3) | 17 (16.2%; 10.2–24.7) | 0.68 | −2.0% (−11.7–7.6) | 0.87 (0.46–1.66) |
  9–24 | 10 (9.4%; 5.1–16.8) | 5 (4.8%; 2.0–11.1) | 0.19 | 4.7% (−2.2–11.6) | 1.98 (0.70–5.60) |
  25–48 | 8 (7.6%; 3.8–14.5) | 5 (4.8%; 2.0–11.1) | 0.40 | 2.8% (−3.7–9.3) | 1.58 (0.54–4.69) |
   > 48 | 6 (5.7%; 2.5–12-2) | 9 (8.6%; 4.5–15.8) | 0.60 | −2.0% (−8.7–4.8) | 0.74 (0.27–2.07) |
 Time spent in hospital (days) | |||||
   < 1 | 42 (39.6%; 25.8 38.4) | 25 (23.8%; 16.5–33.0) | 0.01 | 15.8% (3.4–28.2) | 1.66 (1.10–2.52) |
  1 | 14 (13.2%; 12.1–22.3) | 21 (20.0%; 13.3–28.9) | 0.18 | −6.8% (−16.8–3.2) | 0.66 (0.36–1.23) |
  2 | 8 (7.6%; 5.0–12.6) | 9 (8.6%; 4.5–15.8) | 0.78 | −1.0% (−8.4–6.3) | 0.88 (0.35–2.19) |
  3 | 11 (10.4%; 5.7–13.7) | 8 (7.6%; 3.8–14.6) | 0.48 | 2.8% (−5.0–10.5) | 1.36 (0.57–3.25) |
  4–7 | 16 (15.1%; 14.2–24.9) | 24 (22.9%; 15.7–32.0) | 0.15 | −7.8% (−18.3–2.8) | 0.66 (0.37–1.17) |
   > 7 | 15 (14.2%; 11.3–21.2) | 18 (17.4%; 11.0–25.7) | 0.55 | −3.0% (−12.8–6.8) | 0.83 (0.44–1.55) |
 Itinerary: After discharge from the ED patients were: | |||||
  Transferred to the ICU | 0 (0%; 0–3.4¥) | 1 (1%; 0.1–6.6) | 0.31 | −1.0% (−0.3–0.0) | 0 |
  Transferred to a hospital ward | 52 (49.0%; 39.5–58.6) | 52 (49.5%; 39.9–59.1) | 0.95 | −0.5% (−14.0–13.0) | 0.99 (0.75–1.30) |
  Sent home | 54 (50.9%; 41.4–60.5) | 52 (49.5%; 39.9–59.1) | 0.84 | −1.42% (− 12.1–14.9) | 1.03 (0.79–1.35) |
 Readmission | |||||
  Patients readmitted ≤30 days from discharge | 23 (21.7%; 14.8–30.7) | 23 (21.9%; 14.9–31.0) | 0.97 | −0.26% (−11.3–10.9) | 0.99 (0.59–1.65) |
 Mortality | |||||
  In hospital | 2 (1.9%; 0.2–6.6) | 4 (3.8%; 1.0–9.5) | 0.40 | −1.9% (−6.4–2.6) | 0.49 (0.92–2.64) |
  30 day mortality | 2 (1.9%; 0.2–6.6) | 7 (6.7%; 2.7–13.3) | 0.09 | −4.8% (− 10.2–0.6) | 0.28 (0.06–1.33) |