Whole-Body Point-of-Care Ultrasound in Older Adults Presenting to the Emergency Department After a Fall

This is a prospective, single-center cohort study conducted in the adult emergency department of Kocaeli City Hospital (Kocaeli, Türkiye) over 12 months. Consecutive patients aged 65 years or older presenting after a ground-level fall who give written informed consent (personally or through a legal representative) will be enrolled.

After the initial assessment by the treating emergency physician, demographic data, fall mechanism and history, Glasgow Coma Scale, vital signs, chronic diseases, Charlson Comorbidity Index, Clinical Frailty Scale (Rockwood) and medications (including fall-risk-increasing drugs and recent changes) are recorded. Before ultrasound, the treating physician records his/her working diagnosis and planned consultations, additional tests, minor/major procedures and disposition (admission/discharge/transfer).

A whole-body POCUS examination is then performed by trained emergency medicine residents who are blinded to the clinical information and the physician's plan, using a portable ultrasound device (Esaote MyLab Gamma) with curvilinear, linear and phased-array probes. The protocol includes: carotid artery ultrasound (plaque presence and total plaque area), inferior vena cava diameter and collapsibility, aortic root and abdominal aorta, FAST examination for free fluid, focused cardiac ultrasound (ejection fraction estimate, pericardial effusion, right ventricular strain, valvular pathology), lung ultrasound (pneumothorax; pleural effusion and pulmonary edema when indicated), 3-point compression ultrasound for deep vein thrombosis when there is leg swelling, and quadriceps muscle thickness.

The findings are reported to the treating physician, who makes all clinical decisions independently; the study does not request any additional tests or treatments. The physician then records whether the working diagnosis, consultation needs, additional test requests, need for procedures and disposition decision changed. One-week mortality and repeat emergency department visits are checked through the national e-Nabiz health record system or by telephone.

Sample size: Assuming a 5% baseline (p0) and an expected 13.8% (p1) rate of management change, with alpha = 0.05 and 80% power, the minimum sample size is 93; allowing for 10% loss, 105 patients will be enrolled.

Statistical analysis: Continuous variables will be presented as mean (SD) or median (IQR) according to distribution (Kolmogorov-Smirnov test) and categorical variables as number (%). Groups will be compared with the independent samples t-test or Mann-Whitney U test and the chi-square or Fisher's exact test. Variables associated with a change in management (p<0.10 in univariable analysis) will be entered into multivariable logistic regression; results will be reported as odds ratios with 95% confidence intervals. A two-sided p<0.05 will be considered significant.