Ultrasound guided thoracentesis in the Emergency Department – training and clinical performance

This ph.d. project has the following aims:

1. Describe the current competences and training in thoracentesis in Danish Emergency Departments

1. Develop and evaluate a blended teaching program with spaced simulation training compared to traditional instructor-led classroom teaching.

1. Study how ultrasound-guided bedside thoracentesis with manual fluid removal in the emergency compared to standard thoracentesis by radiologists affects time to complete pleural effusion drainage.

1. Nationwide, cross-sectional study
2. A prospective multicenter, non-inferiority, randomized trial
3. A prospective, investigator-initiated, multicenter, randomized clinical superiority trial

Aarhus University, Regional Hospital Randers, Regional Hospital Horsens, Regional Hospital Goedstrup, Regional Hospital Viborg

Study I: All public somatic hospitals in Denmark with an Emergency Department

Study II: Physicians employed in the Emergency Department in Central Region Denmark

Study III: Inclusion criteria: All patients ≥18 years admitted to the ED with pleural effusion detected by imaging modality with a clinically justified need for thoracentesis. Exclusion criteria: Life-threatening respiratory distress, unable to give consent, previous pleurodesis, pneumothorax, or unacceptably high bleeding risk for thoracentesis according to local guidelines.

Study II:

The control arm will receive a traditional instructor-led course with lectures and simulation-training to acquire competence in thoracentesis

The intervention arm will receive a novel training program using a bundle of e-learning and spaced training (distributing the course curriculum over several weeks with multiple short sessions) to acquire competence in thoracentesis

Study III: 

The control arm will receive current standard of care (passive fluid drainage by a radiologist) The intervention arm wil receive manual fluid drainage in the Emergency Department

Study II: Primary outcome number of participants passing skill-test after completing training. Secondary outcome skills at baseline, number passing skill- test 3 months after training (retention)

Study III: Primary outcome: time from identification of the clinical indication to complete drainage. Secondary outcome: Thoracentesis procedure parameters, length of stay, complication rates and patient satisfaction factors.

This study will contribute with important knowledge on how to optimally acquire competence in ultrasound guided thoracentesis at both a national and international level. The results will help set standards for future evidence-based training for emergency physicians as no guidelines exist for training in thoracentesis. It will also have important clinical implications. It will provide knowledge of any advantages of manual over passive drainage, which may change the common practice among radiologists, pulmonologists, cardiologists, and emergency physicians. Performance of thoracentesis with high quality and safety by emergency physicians will offer patients treatment 24-7-365 leading to improved patient care, symptom relief and likely improve patient satisfaction. Finally, thoracentesis in the ED may result in reduced total hospital length of stay and possibly overall resource expenditure.

Nothing to declare.

Bo Løfgren, Professor, MD, PhD 

Hans Kirkegaard, Professor, MD, PhD, D.M.Sc.

Søren Helbo Skaarup, MD, PhD 

Kasper Glerup Lauridsen, MD, PhD 

Jesper Weile, Associate Professor, MD, PhD