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Hurribunce N, Lalloo V, Prozesky BV, Human R, Prozesky DR, Geyser MM, Engelbrecht A. The use of point-of-care ultrasound in Tshwane public and private sector emergency units. S Afr Fam Pract (2004) 2023; 65:e1-e7. [PMID: 37916695 PMCID: PMC10546228 DOI: 10.4102/safp.v65i1.5711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The use of point-of-care ultrasound (POCUS) is an essential skill in the practice of emergency medicine (EM), with benefit to patient care by improving diagnostic accuracy. Despite this, there exists little data evaluating the use of POCUS in South African emergency units (EUs.). METHODS One hundred and seventeen doctors working in 12 public and private sector EUs in Tshwane were included. A questionnaire was used comprising of descriptive data regarding doctor demographics, levels of experience, and outcome data including POCUS frequency use, training level, indications for, and barriers to its use. RESULTS Many participants were general practitioners working in EUs (58.1%) followed by EM specialists and EM registrars. Of these participants, 88% used POCUS. Seventy one percent received informal POCUS training only. The indications for POCUS use were similar for both public and private sector, with no significant differences in overall use. The only significant association to POCUS use was age ( 33.3 years) and number of years since qualification ( 6.9 years.) Lack of and/or access to training were the main reasons for not using POCUS (18.8%.) There were no significant differences in the barriers to the use of POCUS between the sectors. CONCLUSION Point-of-care ultrasound is used similarly in both public and private sector EUs in Tshwane. Lack of and/or access to POCUS training are the main barrier to its use.Contribution: This study underlines the state of POCUS use in Tshwane and highlights the barriers to its use, thus allowing academic heads and hospital managers to address them.
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Affiliation(s)
- Nirvika Hurribunce
- Department of Family Medicine, Division of Emergency Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and Department of Family Medicine, Division of Emergency Medicine, Faculty of Health Sciences, Kalafong Provincial Tertiary Hospital, Pretoria.
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Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2023; 82:e115-e155. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
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Point-of-care ultrasound: impact on emergency department length of stay for suspected lower extremity DVT. Emerg Radiol 2023; 30:203-207. [PMID: 36917288 DOI: 10.1007/s10140-023-02123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) has demonstrated excellent sensitivity and specificity for the diagnosis of DVT in the emergency department (ED). Before POCUS became widespread, patients underwent radiology department comprehensive lower extremity venous duplex ultrasounds (RADUS) which may be associated with a prolonged length of stay. OBJECTIVES The goal of this study is to evaluate the impact of POCUS on ED arrival to disposition (ATD) time for patients presenting to the ED with suspected lower extremity DVT. METHODS This is a retrospective chart analysis of ED visits to an urban, university-affiliated community hospital from January 2019 to December 2020. This study compared ATD between patients who underwent POCUS by an emergency medicine physician and RADUS by the radiology department. RESULTS In total, 1204 patients underwent POCUS, and 1582 patients were evaluated with RADUS. The POCUS mean ATD was 313 ± 16.8 min compared to the RADUS arm average of 323 ± 57.9 min (p = 0.56). Order to disposition time (OTD) was prolonged among the RADUS group relative to POCUS. ATD was significantly reduced in the POCUS subgroup of patients presenting during night shift when RADUS was not available, 326 ± 28.2 min versus 630 ± 109 min (p < 0.05). CONCLUSION ED POCUS scans decrease the amount of time between order placement and disposition when compared to RADUS. POCUS significantly decreases length of stay in the ED when RADUS is not available.
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Russ B, Arthur J, Lewis Z, Snead G. A REVIEW OF LAWSUITS RELATED TO POINT-OF-CARE EMERGENCY ULTRASOUND APPLICATIONS. J Emerg Med 2022; 63:661-672. [PMID: 35953324 DOI: 10.1016/j.jemermed.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/22/2022] [Accepted: 04/23/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Previous investigators have assessed United States Case Law to evaluate the medicolegal risk surrounding point-of-care ultrasound applications. These studies have suggested that nonperformance is the primary source of an allegation of medical malpractice. OBJECTIVES The objective of this study is to update the literature regarding medical malpractice cases involving ultrasound applications that could be used at the point of care, and assess the risk conveyed to advanced practice providers and by application of emerging applications of ultrasound. METHODS Authors reviewed the Westlaw database for medical malpractice cases involving point-of-care ultrasound applications between December 2012 and January 2021. Cases were included if there was an allegation of misconduct by an emergency provider and if an ultrasound included in the American College of Emergency Physicians investigators core, extended, emerging, or adjunct applications was discussed to any degree. Investigators independently reviewed the cases for inclusion. Authors abstracted the case information, type of ultrasound performed, and the specific allegation of misconduct. RESULTS Nineteen cases met inclusion criteria. Seven cases involved core applications of emergency ultrasound and 13 involved extended, emerging, or adjunct applications. One case was included in both categories as it included elements of both core and extended applications. The most common primary allegation was failure to perform an ultrasound. No cases clearly alleged misinterpretation of a point-of-care ultrasound. CONCLUSION As previous studies have suggested, nonperformance of ultrasound seems to convey the greatest medicolegal risk. Extended, emerging, or adjunct applications of ultrasound may convey a slightly higher risk.
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Affiliation(s)
- Brian Russ
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Jason Arthur
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | - Zachary Lewis
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Gregory Snead
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Rudnin S, Kaminsky J, Ghosh R, Webb R, Fu W, Tama M, Hayim M, Hahn B, Greenstein J. Distribution of Lower Extremity Deep Vein Thrombosis and Implications for Limited Compression Ultrasound Examinations. J Emerg Med 2022; 63:348-354. [PMID: 36115745 DOI: 10.1016/j.jemermed.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/18/2022] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Limited compression bedside ultrasonography (LCUS) including two-point, three-point, and extended compression examinations have become increasingly popular among emergency physicians to assess for lower extremity deep venous thrombosis (DVT). OBJECTIVE Our objective in this study was to determine the prevalence and distribution of lower extremity DVT in sites identified by complete duplex ultrasonography (CDUS) that may potentially be missed using limited compression ultrasonography techniques. METHODS This was a retrospective, multicenter study conducted at 12 hospitals within the Northwell Health system over a span of 4 years. Study participants (emergency department patients) underwent CDUS to assess for possible DVT. Images were reviewed and interpreted by radiologists and vascular surgeons at each of the participating institutions. RESULTS A total of 42,487 CDUS examinations were performed, of which 3383 were positive for DVT. DVTs were deemed to be acute in 2664 (79%) and chronic in the remaining 21% on the basis of comparison with previous studies and appearance of the vein. Of the acute DVTs, 136 (5.1%) were confined to the common femoral vein, 116 (4.4%) to the femoral vein, 8 (0.3%) to deep femoral vein, 213 (8.0%) to popliteal vein, and 934 (35.1) to calf veins alone. CONCLUSIONS In our study, a significant number of DVTs were identified in sites that may have been potentially missed on LCUS examinations, thereby supporting the use of complete duplex ultrasonography when available.
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Affiliation(s)
- Simone Rudnin
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Jennifer Kaminsky
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Radhika Ghosh
- Department of Pediatrics, Northwell Health, Emory University Hospital, Atlanta, Georgia
| | - Ryan Webb
- Department of Radiology, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Wayne Fu
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Maria Tama
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Morris Hayim
- Department of Radiology, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Barry Hahn
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
| | - Josh Greenstein
- Department of Emergency Medicine, Northwell Health, Staten Island University Hospital, Staten Island, New York
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Cardiac and vascular point-of-care ultrasound: current situation, problems, and future prospects. J Med Ultrason (2001) 2022; 49:601-608. [PMID: 34997377 PMCID: PMC8741534 DOI: 10.1007/s10396-021-01166-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/21/2021] [Indexed: 11/15/2022]
Abstract
Although clinical application of ultrasound to the heart has a history of about 80 years, its big turning point was the emergence of a portable ultrasound diagnostic machine. As a result, the place, where echocardiography is performed widely spread outside the examination room, and the people who perform echocardiography have also greatly increased. Emergency physicians, anesthesiologists, and primary care physicians became interested in echocardiography and started using it. Such ultrasound examinations performed by a doctor for assessment of disease condition, management, or guidance of treatment at bedside has been called point-of-care ultrasound (POCUS). Cardiac POCUS is divided into a focused cardiac ultrasound examination (FoCUS) and limited echocardiography. The former is performed by non-experts in echocardiography, such as emergency physicians and anesthesiologists, whereas the latter is usually performed by cardiologists who are experts in echocardiography. FoCUS has an established protocol and evaluation method, and evidence to prove its effectiveness is accumulating. In addition, the COVID-19 outbreak reaffirmed the importance of POCUS. Although FoCUS is becoming popular in Japan, an educational program has not been established, and discussion on how to educate medical students and residents will be necessary. Even if POCUS in cardiovascular medicine becomes widespread, auscultation will still be necessary. Rather, adding cardiac and vascular POCUS to inspection, palpation, and auscultation in the flow of physical examinations will benefit patients greatly.
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Varrias D, Palaiodimos L, Balasubramanian P, Barrera CA, Nauka P, Melainis AA, Zamora C, Zavras P, Napolitano M, Gulani P, Ntaios G, Faillace RT, Galen B. The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis. J Clin Med 2021; 10:3903. [PMID: 34501350 PMCID: PMC8432124 DOI: 10.3390/jcm10173903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/24/2022] Open
Abstract
Acute lower extremity proximal deep venous thrombosis (DVT) requires accurate diagnosis and treatment in order to prevent embolization and other complications. Point-of-care ultrasound (POCUS), a clinician performed, and clinician interpreted bedside ultrasound examination has been increasingly used for DVT evaluation mainly in the urgent and critical care setting, but also in the ambulatory clinics and the medical wards. Studies have demonstrated that POCUS has excellent diagnostic accuracy for acute proximal DVT when performed by well-trained users. However, there is significant heterogeneity among studies on the necessary extent of training and universally acceptable standardized education protocols are needed. In this review, we summarize the evidence that supports the use of POCUS to diagnose acute proximal DVT and focus on methodology and current technology, sensitivity and specificity, pre-test probability and the role of D-dimer, time and resources, education, limitations, and future directions.
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Affiliation(s)
- Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Prasanth Balasubramanian
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian A Barrera
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Peter Nauka
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Angelos Arfaras Melainis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Christian Zamora
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Phaedon Zavras
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Marzio Napolitano
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Perminder Gulani
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - George Ntaios
- Department of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece;
| | - Robert T. Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Bronx, NY 10461, USA; (P.B.); (C.A.B.); (A.A.M.); (C.Z.); (P.Z.); (M.N.); (P.G.); (R.T.F.)
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
| | - Benjamin Galen
- Albert Einstein College of Medicine, Bronx, NY 10461, USA; (P.N.); (B.G.)
- Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA
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Khanyi HB, Naicker B. The use of point-of-care ultrasound in a regional emergency department in KwaZulu-Natal, South Africa. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34476962 PMCID: PMC8424764 DOI: 10.4102/safp.v63i1.5269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/03/2021] [Accepted: 06/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background Formal ultrasonography has advanced to point-of-care ultrasound (POCUS) in the emergency department (ED) for the purpose of acute critical care. While POCUS application expands, little is known about POCUS utilisation in public hospital EDs. This study aimed to describe the use of POCUS in an ED in KwaZulu-Natal. Methods A retrospective chart review study was conducted on all patients who had POCUS exams performed in the ED at the General Justice Gizenga Mpanza Regional Hospital from 01 September 2019 to 31 March 2020. A data collection tool was used to extract the required data from the Mindray M6 ultrasound machine. The data were processed using the Statistical Package for Social Sciences (SPSS version 26) and descriptive statistics were used to summarise the data. Results A total of 978 POCUS were performed on 784 patients. Point-of-care ultrasound was utilised more often for focused emergency echocardiography in resuscitation (n = 383) and extended focused assessment with sonography for trauma (n = 319). The findings were normal in 17% of exams, 31% were positive, 9% were unspecified and 43% of POCUS exams were inconclusive. Seven percent of POCUS exams were performed by accredited level 1 emergency POCUS providers and ultrasounds occurred more frequently during day-shift hours than after-hours. Conclusion Point-of-care ultrasound core applications were utilised by ED doctors for various emergency care scenarios, mainly for trauma and cardiac assessments.
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Affiliation(s)
- Halalisiwe B Khanyi
- Division of Emergency Medicine, School of Clinical Medicine, University of KwaZulu-Natal, Durban.
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White M, Betensky M, Lawson SL, Goldenberg NA. Community-Onset Venous Thromboembolism in Children: Pediatric Emergency Medicine Perspectives. Semin Thromb Hemost 2021; 47:623-630. [PMID: 33971683 DOI: 10.1055/s-0041-1725117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric venous thromboembolism (VTE) is a condition increasingly encountered by emergency medicine physicians. Unfortunately, despite increased incidence, the diagnosis of pediatric VTE relies on a high index of suspicion from clinicians. Delays in diagnosis and initiation of treatment can lead to poor outcomes in children, including an increased risk of mortality from pulmonary embolism, increased risk of VTE recurrence, and the development of the post-thrombotic syndrome. The majority of pediatric VTE events are associated with the presence of at least one underlying prothrombotic risk. Timely recognition of these risk factors in the emergency department (ED) setting is paramount for a prompt diagnosis and treatment initiation. Compared with children with hospital-acquired VTE, children presenting to the ED with new onset VTE tend to be older (>11 years of age), have a lower incidence of co-morbidities, and present more frequently with a deep venous thrombosis of the lower extremity. Currently, there are no validated pediatric-specific VTE clinical pretest probability tools that reliably assist with the accurate and timely diagnosis of pediatric VTE. Compression ultrasound with Doppler is the most common imaging modality used for VTE diagnosis, and low molecular weight heparins are the most common anticoagulants initiated in children presenting with VTE in the ED. Special consideration should be given to patients who present to the ED already on anticoagulation therapy who may require acute management for clinically-significant bleeding or change in antithrombotic therapy approach for progression/recurrence of VTE.
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Affiliation(s)
- Melissa White
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Marisol Betensky
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Institute of Clinical and Translation Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Simone L Lawson
- Departments of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Neil A Goldenberg
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Institute of Clinical and Translation Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ahmed El-Gazzar EH, Alkafafy AM, El-Salam Fathi HA, Helmi TA, Abd-Rabo AAE. Sensitivity and specificity of three-point compression ultrasonography test performed by emergency physicians for diagnosis of lower limbs deep venous thrombosis. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | - Hassan Abd El-Salam Fathi
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tamer Abdullah Helmi
- Critical Care Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Assem Abd-Elrazek Abd-Rabo
- Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Agreement between emergency physicians and radiologists for the diagnosis of deep venous thrombosis with compression ultrasound: a prospective study. Eur J Emerg Med 2021; 28:25-28. [PMID: 32657823 DOI: 10.1097/mej.0000000000000728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The time factor in diagnosis and management of a deep vein thrombosis of the lower extremities (LE DVT) is of increasing importance in the era of crowding of emergency departments (ED). Current techniques used to detect LE DVT include a two-point regional compression ultrasound (rCUS), yet assessments are usually performed only during office hours. Outside office hours ultrasonography is postponed and low molecular weight heparin (LMWH) prescribed. OBJECTIVES Primary outcome of the study was to assess the level of agreement in rCUS for LE DVT when performed by Dutch emergency physicians compared to rCUS by a radiologist. Secondary outcome was time to diagnosis. METHOD We performed a single-blind cohort study. All consecutive patients aged 18 years and older attending the ED with clinical suspicion of LE DVT were considered eligible for study enrolment. rCUS was ordered at the radiology department; subsequently, the bedside rCUS examination was also performed in the ED by the emergency physicians or ED residents. RESULTS A total of 138 patients were included, of whom 28 patients were diagnosed with DVT by a radiologist. Emergency physicians and radiologists showed comparable agreement [absolute agreement 94% (P < 0.001), Cohen's Kappa 0.87]. Emergency physicians decreased overall time to diagnosis by 01:04 h, ED residents showed comparable results. During out-of-office hours, time benefit was 16:39 h on weekdays and 18:40 h during weekends. CONCLUSION Emergency physicians show comparable agreement in diagnosing LE DVT using rCUS when compared to radiologists. Average time benefit is over an hour, thereby reducing unnecessary waiting and improving time to disposition. ED residents demonstrated similar results in both agreement and time-saving.
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Ray JW, Gende AM, Hall MM, Coe I, Situ-LaCasse E, Waterbrook A. Ultrasound in Trauma and Other Acute Conditions in Sports, Part II. Curr Sports Med Rep 2020; 19:546-551. [DOI: 10.1249/jsr.0000000000000788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Canakci ME, Acar N, Bilgin M, Kuas C. Diagnostic value of point-of-care ultrasound in deep vein thrombosis in the emergency department. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:527-531. [PMID: 32643227 DOI: 10.1002/jcu.22892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) has been demonstrated as one of the primary diagnostic tools for deep vein thrombosis (DVT) screening in the emergency department, but there are quite different results in the literature regarding its diagnostic value. The aim of this study is to assess the diagnostic value of POCUS in DVT diagnosis. METHODS Patients with a clinical suspicion of DVT who underwent POCUS and were monitored by the radiology department via ultrasonography (US) or venography for DVT were retrospectively examined. POCUS examination for DVT was performed in the femoral and popliteal regions by a two-point compression technique. The inclusion criteria were age >18 years and patients with both a POCUS report and venography or US examinations performed by the radiology department (RUS) and reported by the radiology clinic. RUS and venography were considered as the gold standards. RESULTS The study included 266 patients. POCUS had a sensitivity of 93% (95% CI: 84-98) and specificity of 93% (95% CI: 89-96). Its positive likelihood ratio (LR+ ) was 14 (95% CI: 8-24), and its negative likelihood ratio (LR- ) was 0.08 (95% CI: 0.03-0.19). POCUS also had a positive predictive value (PPV) of 83% (95% CI: 74-89) and a negative predictive value (NPV) of 97% (95% CI: 94-99). CONCLUSIONS Our study verifies that POCUS has high specificity and sensitivity for the examination of the popliteal and femoral veins by an emergency physician to evaluate patients with a preliminary diagnosis of DVT.
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Affiliation(s)
- Mustafa Emin Canakci
- Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Nurdan Acar
- Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Biostatistics Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey
| | - Caglar Kuas
- Emergency Department, Yildirim Beyazit University Yenimahalle Training And Research Hospital, Ankara, Turkey
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Shiloh AL, McPhee C, Eisen L, Koenig S, Millington SJ. Better With Ultrasound: Detection of DVT. Chest 2020; 158:1122-1127. [PMID: 32087215 DOI: 10.1016/j.chest.2020.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/04/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022] Open
Abstract
Ultrasound studies to detect DVT are traditionally performed and interpreted by sonographers and radiologists, respectively, but the growth of point-of-care ultrasound is putting this powerful tool in the hands of front-line physicians. Literature from ambulatory patients in the ED suggests this tool performs well in the hands of nonconventional users, and it is now being commonly deployed to aid in the management of critically ill patients. This article presents an approach for incorporating these tools into bedside practice, including illustrative figures and narrated video presentations to demonstrate the techniques described.
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Affiliation(s)
- Ariel L Shiloh
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Christa McPhee
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Lewis Eisen
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Seth Koenig
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
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15
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Murray A. The good, the bad and the ugly of point-of-care ultrasound. Emerg Med Australas 2020; 32:158-159. [PMID: 31927776 DOI: 10.1111/1742-6723.13454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Alistair Murray
- Emergency Department, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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16
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Boniface MP, Helgeson SA, Cowdell JC, Simon LV, Hiroto BT, Werlang ME, Robison SW, Edwards GG, Lewis MD, Maniaci MJ. A Longitudinal Curriculum In Point-Of-Care Ultrasonography Improves Medical Knowledge And Psychomotor Skills Among Internal Medicine Residents. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:935-942. [PMID: 31807108 PMCID: PMC6839571 DOI: 10.2147/amep.s220153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 05/29/2023]
Abstract
PURPOSE Despite its growing popularity and clinical utility among hospital-based physicians, there are no formal competency requirements nor training standards for United States based Internal Medicine Residencies for learning point-of-care ultrasonography (POCUS). The purpose of this investigation was to study the impact and effectiveness of a novel POCUS curriculum for an Internal Medicine (IM) residency program. PATIENTS AND METHODS This was a Single-Group Educational Quasi-Experiment involving Categorical and Preliminary Internal Medicine Residents in Post-Graduate Years 1 through 3 at a single United States academic tertiary center. The study period was from January 1, 2017, through June 30, 2017, during which time the residents participated in monthly modules including didactics and hands-on ultrasound scanning skills with live models. Participants completed a comprehensive knowledge examination at the beginning and end of the six-month period. Participants were also tested regarding hands-on image acquisition and interpretation immediately before and after the hands-on skills labs. The primary outcome measure was performance improvement in a comprehensive medical knowledge assessment. RESULTS In total, 42 residents consented for participation. The residents' monthly rotations were adjusted in order to accommodate the new educational process. Among 29 participants with complete data sets for analysis, the mean (SD) comprehensive knowledge examination score improved from 60.9% before curriculum to 70.2% after curriculum completion (P<0.001). Subgroup analysis determined that improvement in medical knowledge required attending at least 2 out of the 6 (33%) educational sessions. Attendance at hands-on skills labs correlated significantly with improvement; didactics alone did not. CONCLUSION A longitudinal POCUS curriculum consisting of both didactic sessions and hands-on skills labs improves knowledge, image acquisition, and interpretation skills of residents. Having this curriculum span at least 6 months provides learners the opportunity to attend multiple classes which strengthens learning through repetition while also providing learners flexibility in schedule.
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Affiliation(s)
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jed C Cowdell
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Brett T Hiroto
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Monia E Werlang
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah W Robison
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Grace G Edwards
- Department of Education, Mayo Clinic, Jacksonville, FL, USA
- The Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michele D Lewis
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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17
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Cleveland Manchanda EC, Kharasch SJ, Liteplo AS. Dyspnea in an Otherwise Healthy 18-year-old: The Importance of Point-of-care Ultrasonography. Clin Pract Cases Emerg Med 2019; 3:271-274. [PMID: 31404178 PMCID: PMC6682241 DOI: 10.5811/cpcem.2018.9.39218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 11/11/2022] Open
Abstract
A healthy 18-year-old male presented to the emergency department with chest pain, palpitations, and dyspnea. His exam was unremarkable; however, point-of-care ultrasound (POCUS) revealed right ventricular strain with a D-sign and enlarged right ventricle. He subsequently reported a history of factor V Leiden. His D-dimer was markedly elevated, and a computed tomography angiogram of the chest demonstrated submassive pulmonary embolism (PE). He was taken to the catheterization lab for directed thrombolysis and was discharged in good condition two days later. Factor V Leiden is the most common genetic cause of venous thromboembolism. POCUS can facilitate rapid diagnosis and risk stratification of patients with acute PE.
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Affiliation(s)
| | - Sigmund J Kharasch
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Andrew S Liteplo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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18
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Tarrazo Suárez JA, Morales Cano JM, Pujol Salud J, Sánchez Barrancos IM, Diaz Sánchez S, Conangla Ferrín L. [Usefulness and reliability of point of care ultrasound in Family Medicine: Focused ultrasound in neck and emergency]. Aten Primaria 2019; 51:367-379. [PMID: 31101376 PMCID: PMC6836943 DOI: 10.1016/j.aprim.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022] Open
Abstract
La ecografía clínica es una herramienta que complementa a la anamnesis y a la exploración física, lo que facilita y agiliza la toma de decisiones en cualquier entorno de atención médica El médico de familia es el especialista que más se puede beneficiar del empleo de la ecografía porque debe ser competente en todos los terrenos de la enfermedad El estudio mediante ecografía, por su fiabilidad, seguridad, reproducibilidad y bajo coste debe estar accesible para su empleo en atención primaria, tanto en el ámbito de la atención normal como la urgente Esta técnica, aplicada en escenarios concretos y con una sistemática de estudio definida, confirma o descarta enfermedades, lo que orienta el diagnóstico con elevada fiabilidad, así como sustenta de modo eficaz la conducta del profesional Este artículo revisa la fiabilidad y la utilidad de la ecografía clínica en escenarios como la enfermedad cervical, y en diferentes situaciones de urgencia, como sospecha de trombosis venosa profunda en la extremidad inferior, traumatismo toracoabdominal, inestabilidad hemodinámica o parada cardiaca
La ecografía es una herramienta de gran valor para el diagnóstico y el manejo de una gran variedad de situaciones clínicas cotidianas. El médico de familia como especialista generalista debe ser competente para el abordaje de prácticamente cualquier problema de salud que afecte a su población, por lo que, en sus manos, esta herramienta puede proporcionar un elevado impacto sobre la calidad y la eficacia del proceso asistencial. Este es el último artículo de una serie dedicada a mostrar la aplicabilidad de la ecografía clínica en nuestras manos, en la que hemos revisado la mayoría de sus aplicaciones, como la ecografía clínica abdominal, la nefrourológica, la musculoesquelética, la cardiaca o la pulmonar. Queremos terminar con escenarios como la afección del cuello o su uso en situaciones de urgencia, en las que proporciona datos definitivos para la orientación diagnóstica, el manejo clínico e incluso la supervivencia del paciente, tales como el paciente con sospecha de trombosis venosa profunda en miembros inferiores, traumatismo toracoabdominal, compromiso hemodinámico o parada cardiaca.
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Affiliation(s)
- José Antonio Tarrazo Suárez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Siero-Sariego, Servicio Asturiano de Salud, Pola de Siero, Asturias, España
| | - José Manuel Morales Cano
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Ciudad Real 2, Servicio de Salud de Castilla-La Mancha, Ciudad Real, España
| | - Jesús Pujol Salud
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Balaguer, Instituto Catalán de Salud, Balaguer, Lleida, España
| | - Ignacio Manuel Sánchez Barrancos
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Consultorio de Membrilla, Centro de Salud Manzanares 2, Servicio de Salud de Castilla-La Mancha, Membrilla, Ciudad Real, España.
| | - Santiago Diaz Sánchez
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Salud Pintores de Parla, Servicio Madrileño de Salud, Parla, Madrid. España
| | - Laura Conangla Ferrín
- Medicina Familiar y Comunitaria; Grupo de Trabajo de Ecografía, Sociedad Española de Medicina Familiar y Comunitaria; Centro de Atención Primaria Badalona-2, Centre Dalt la Vila, Instituto Catalán de Salud, Badalona, Barcelona, España
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19
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Lee JH, Lee SH, Yun SJ. Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department: A meta-analysis. Medicine (Baltimore) 2019; 98:e15791. [PMID: 31145304 PMCID: PMC6709014 DOI: 10.1097/md.0000000000015791] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To our knowledge, so far, no studies have comprehensively examined the performance of 2-point and 3-point point-of-care compression ultrasound (POCUS) in the diagnosis of lower extremity deep vein thrombosis (DVT). The aim of this meta-analysis was to compare the performance of 2-point and 3-point POCUS techniques for the diagnosis of DVT and evaluate the false-negative rate of each POCUS method. METHODS A computerized search of the PubMed, EMBASE, and Cochrane library databases was performed to identify relevant original articles. Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the diagnostic performance of 2-point and 3-point POCUS. The pooled proportions of the false-negative rate for each POCUS method were assessed using a DerSimonian-Laird random-effects model. Meta-regression analyses were performed according to the patient and study characteristics. RESULTS Seventeen studies from 16 original articles were included (2-point, 1337 patients in 9 studies; 3-point, 1035 patients in 8 studies). Overall, 2-point POCUS had similar pooled sensitivity [0.91; 95% confidence interval (95% CI), 0.68-0.98; P = .86) and specificity (0.98; 95% CI, 0.96-0.99; P = .60) as 3-point POCUS (sensitivity, 0.90; 95% CI, 0.83-0.95 and specificity, 0.95; 95% CI, 0.83-0.99). The false-negative rates of 2-point (4.0%) and 3-point POCUS (4.1%) were almost similar. Meta-regression analysis showed that high sensitivity and specificity tended to be associated with an initial POCUS performer (including attending emergency physician > only resident) and separate POCUS training for DVT (trained > not reported), respectively. CONCLUSION Both 2-point and 3-point POCUS techniques showed excellent performance for the diagnosis of DVT. We recommend that POCUS-trained attending emergency physicians perform the initial 2-point POCUS to effectively and accurately diagnose DVT.
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Affiliation(s)
- Ju Hyung Lee
- Department of Medical Service, 8311 unit, the Republic of Korea Air Force, Chungcheongnam-do
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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20
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Point-of-care ultrasonography in the allergy and immunology clinic. Ann Allergy Asthma Immunol 2019; 123:42-47. [PMID: 30776445 DOI: 10.1016/j.anai.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 02/09/2019] [Accepted: 02/10/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To summarize evidence supporting the use of point-of-care ultrasonography as a clinical tool for allergists and immunologists. DATA SOURCES Cochrane Library, Medline, EMBASE, and Scopus databases were searched for articles published before December 18, 2018. STUDY SELECTIONS We included any retrospective or prospective study that evaluated ultrasonography in allergy and immunology and epinephrine autoinjector (EAI) needle length. RESULTS The standard EAI needle length may be inadequate for intramuscular delivery of epinephrine, particularly for women, at risk of anaphylaxis. In patients who weigh less than 15 kg, the lengths of commercially available EAIs may be too long, risking inadvertent intraosseous injection and resultant complications. Ultrasonography can be routinely used in the allergy clinic to guide needle length and angle for subcutaneous allergen immunotherapy injections to minimize systemic adverse effects. CONCLUSION Point-of-care ultrasonography can be a useful tool to enhance patient care and safety in an allergy clinic. Ideally, all patients prescribed EAIs should have ultrasonographic measurement of the skin to muscle distance and skin to bone distance to assist in identifying patients at risk of subcutaneous or intraosseous injection in anaphylaxis and those at risk of intramuscular injection during subcutaneous allergen immunotherapy injections.
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21
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Seyedhosseini J, Fadavi A, Vahidi E, Saeedi M, Momeni M. Impact of point-of-care ultrasound on disposition time of patients presenting with lower extremity deep vein thrombosis, done by emergency physicians. Turk J Emerg Med 2017; 18:20-24. [PMID: 29942878 PMCID: PMC6009805 DOI: 10.1016/j.tjem.2017.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/23/2017] [Accepted: 12/12/2017] [Indexed: 11/24/2022] Open
Abstract
Background Point-of-care venous compression ultrasound (VCU) is highly accurate in deep vein thrombosis (DVT) diagnosis; however, waiting to perform this exam by radiologists, may cause delay in patients' disposition. Objective To compare the effect of point-of-care VCU on patients' disposition time, done by emergency physician versus radiologists. Methods A total of 50 patients suspected of having lower extremity DVT, were randomized into 2 equal groups and they underwent a point-of-care VCU performed either by an emergency physician (emergency medicine (EM) group) or a radiologist (radiology group). The mean time of patients' disposition and management were compared between the two groups. Results The EM group consisted of 16 males and 9 females while the radiology group consisted of 13 males and 12 females. The median time elapsed from triage to performing ultrasonography and the median time elapsed from triage to final disposition were significantly lower in the EM group than those in the radiology group (50 min vs. 142 min, and 69 min vs. 260 min, respectively; p < .001). The final diagnosis was confirmed to be DVT in 14 patients (56%) in the EM group and in 17 patients (68%) in the radiology group (p = .38). There was no false positive or negative diagnosis. Conclusions Performing VCU in patients suspected of having DVT by a trained emergency physician could significantly reduce the time of patients' disposition in the emergency setting.
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Affiliation(s)
- Javad Seyedhosseini
- Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Iran
| | - Arash Fadavi
- Kermanshah University of Medical Sciences, Emergency Medicine Research Center, Iran
| | - Elnaz Vahidi
- Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Iran
| | - Morteza Saeedi
- Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Department, Iran
| | - Mehdi Momeni
- Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Department, Iran
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22
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Zuker-Herman R, Ayalon Dangur I, Berant R, Sitt EC, Baskin L, Shaya Y, Shiber S. Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis. J Thromb Thrombolysis 2017; 45:99-105. [DOI: 10.1007/s11239-017-1595-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2017; 69:e27-e54. [PMID: 28442101 DOI: 10.1016/j.annemergmed.2016.08.457] [Citation(s) in RCA: 393] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Indexed: 02/06/2023]
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24
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Point-of-Care Ultrasound Identification of Internal Jugular Vein Thrombosis in Newly Diagnosed Lymphoma. Pediatr Emerg Care 2017; 33:800-802. [PMID: 29095387 DOI: 10.1097/pec.0000000000001333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a child who presented with neck swelling and was ultimately diagnosed with lymphoma after an internal jugular vein thrombosis was discovered by point-of-care ultrasound. The use of point-of-care ultrasound enabled thrombus detection, which prompted further evaluation and treatment.
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25
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Pomero F, Borretta V, Bonzini M, Melchio R, Douketis JD, Fenoglio LM, Dentali F. Accuracy of emergency physician–performed ultrasonography in the diagnosis of deep-vein thrombosis. Thromb Haemost 2017; 109:137-45. [DOI: 10.1160/th12-07-0473] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/14/2012] [Indexed: 11/05/2022]
Abstract
SummaryDuplex ultrasound is the first-line diagnostic test for detecting lower limb deep-vein thrombosis (DVT) but it is time consuming, requires patient transport, and cannot be interpreted by most physicians. The accuracy of emergency physician–performed ultrasound (EPPU) for the diagnosis of DVT, when performed at the bedside, is unclear. We did a systematic review and meta-analysis of the literature, aiming to provide reliable data on the accuracy of EPPU in the diagnosis of DVT. The MEDLINE and EMBASE databases (up to August 2012) were systematically searched for studies evaluating the accuracy of EPPU compared to either colour-flow duplex ultrasound performed by a radiology department or vascular laboratory, or to angiography, in the diagnosis of DVT. Weighted mean sensitivity and specificity and associated 95% confidence intervals (CIs) were calculated using a bivariate random-effects regression approach. There were 16 studies included, with 2,379 patients. The pooled prevalence of DVT was 23.1% (498 in 2,379 patients), ranging from 7.4% to 47.3%. Using the bivariate approach, the weighted mean sensitivity of EPPU compared to the reference imaging test was 96.1% (95%CI 90.6–98.5%), and with a weighted mean specificity of 96.8% (95%CI:94.6–98.1%). Our findings suggest that EPPU may be useful in the management of patients with suspected DVT. Future prospective studies are warranted to confirm these findings.
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Schroeder M, Shorette A, Singh S, Budhram G. Phelgmasia Cerulea Dolens Diagnosed by Point-of-Care Ultrasound. Clin Pract Cases Emerg Med 2017; 1:104-107. [PMID: 29849409 PMCID: PMC5965407 DOI: 10.5811/cpcem.2016.12.32716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/11/2016] [Accepted: 12/13/2016] [Indexed: 11/11/2022] Open
Abstract
Phlegmasia cerulea dolens (PCD) is a rare entity that is associated with significant morbidity and mortality, including limb ischemia and pulmonary embolism. Point-of-care ultrasound (POCUS) can expedite the diagnosis, leading to earlier life- and limb-saving treatment. Although primarily used for assessing for the presence of deep venous thrombosis, in the appropriate clinical setting POCUS can also be used to diagnosis PCD as well as to distinguish between venous and arterial occlusion, which can lead to a difference in management. We present a case of phlegmasia cerulea dolens after mild trauma in a patient with an underlying hypercoagulability disorder diagnosed by an emergency physician using POCUS, which expedited treatment with catheter-directed thrombolytic therapy.
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Affiliation(s)
- Michele Schroeder
- University of Massachusetts Medical School-Baystate Health Springfield Campus, Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
| | - Amanda Shorette
- University of Massachusetts Medical School-Baystate Health Springfield Campus, Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
| | - Sukhdeep Singh
- University of Massachusetts Medical School-Baystate Health Springfield Campus, Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
| | - Gavin Budhram
- University of Massachusetts Medical School-Baystate Health Springfield Campus, Baystate Medical Center, Department of Emergency Medicine, Springfield, Massachusetts
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27
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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28
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Jones SD, Fischer J, Kwan C, Tessaro M. Traumatic Femoral Artery Thrombosis Diagnosed by Point-of-Care Ultrasonography in the Pediatric Emergency Department. Pediatr Emerg Care 2016; 32:885-887. [PMID: 27898631 DOI: 10.1097/pec.0000000000000967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Femoral artery injuries are a rare complication of blunt trauma in children that require expeditious diagnosis and treatment to prevent permanent limb dysfunction. Point-of-care ultrasonography of femoral vessels is a well-established emergency physician technique for ruling out deep vein thrombosis and guiding femoral vessel catheterization. We present the first report of a pediatric emergency physician diagnosing a traumatic femoral artery thrombus using point-of-care ultrasonography.
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Affiliation(s)
- Sarah D Jones
- From the Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
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29
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Doctor M, Olivieri P, Siadecki SD, Rose G, Drake A, Saul T. Sonographer preference of ballistic gelatin concentration used to create DVT training phantoms. Am J Emerg Med 2016; 35:178-179. [PMID: 28340983 DOI: 10.1016/j.ajem.2016.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michael Doctor
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Patrick Olivieri
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Sebastian D Siadecki
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Gabriel Rose
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Aaran Drake
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY
| | - Turandot Saul
- Department of Emergency Medicine, Mount Sinai St. Luke's Mount Sinai West, New York, NY.
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30
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Normahani P, Aslam M, Standfield NJ, Jaffer U. The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia. Perfusion 2016; 32:74-80. [PMID: 27451053 DOI: 10.1177/0267659116661049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To establish the diagnostic accuracy of a 'focused vascular lower limb arterial duplex scan (F-VLAD)' developed to facilitate rapid decision-making for acute limb ischaemia (ALI). METHODS Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original 'full' duplex ultrasound (DUS) pictorial reports were 're-formatted' to include only anatomical segments included in the 'F-VLAD' scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis). RESULTS Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and 'full' DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively. CONCLUSION The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.
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Affiliation(s)
- Pasha Normahani
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Mohammed Aslam
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Nigel J Standfield
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
| | - Usman Jaffer
- Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, UK
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Mulcare MR, Lee RW, Pologe JI, Clark S, Borda T, Sohn Y, Sacco DL, Riley DC. Interrater reliability of emergency physician-performed ultrasonography for diagnosing femoral, popliteal, and great saphenous vein thromboses compared to the criterion standard study by radiology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:360-367. [PMID: 26890934 DOI: 10.1002/jcu.22338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To assess the interrater reliability and test characteristics of lower limb sonographic examination for the diagnosis of deep venous and proximal great saphenous vein thrombosis when performed by Emergency Physicians (EPs) as compared to that by the Department of Radiology (Radiology). The secondary objective was to assess the effects of patient body mass index and EP satisfaction with bedside ultrasound on sensitivity and specificity. METHODS A prospective study was conducted for patients with clinical suspicion for lower extremity thrombus. EPs evaluated for venous thrombosis in the common femoral vein, femoral vein of the thigh, popliteal vein, and proximal great saphenous vein. Subsequently, all patients received ultrasounds by Radiology, the criterion standard. RESULTS One hundred ninety-seven patients (257 individual legs) were evaluated. There was 90-95% agreement between EP and Radiology, moderate kappa agreement for common femoral vein, and femoral vein of the thigh and fair kappa agreement for great saphenous vein and popliteal vein. The sensitivity and specificity of EP ultrasounds compared with criterion standard were lower than previously reported. There was no trend in patient body mass index or provider satisfaction influencing the test characteristics. CONCLUSIONS Our study suggests that point-of-care sonography should not replace Radiology-performed scans. The required amount of training for EPs to be competent in this examination needs further investigation. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:360-367, 2016.
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Affiliation(s)
- Mary R Mulcare
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
- Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York
| | - Randall W Lee
- Division of Emergency Medicine, Columbia University Medical Center, New York, New York
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Jonas I Pologe
- Division of Emergency Medicine, Columbia University Medical Center, New York, New York
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Sunday Clark
- Division of Emergency Medicine, Weill Cornell Medical College, New York, New York
- Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York
| | - Tomas Borda
- Department of Family Medicine, The Brooklyn Hospital Center, Brooklyn, New York
| | - Youdong Sohn
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - Dana L Sacco
- Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York
- Division of Emergency Medicine, Columbia University Medical Center, New York, New York
| | - David C Riley
- Emergency Medicine Residency, New York-Presbyterian Hospital, New York, New York
- Division of Emergency Medicine, Columbia University Medical Center, New York, New York
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James V, Alsani FS, Fregonas C, Seguin J, Tessaro MO. Point-of-care ultrasound in pediatric small bowel obstruction: an ED case series. Am J Emerg Med 2016; 34:2464.e1-2464.e2. [PMID: 27317480 DOI: 10.1016/j.ajem.2016.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Vigil James
- Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
| | - Faisal S Alsani
- Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
| | - Claudio Fregonas
- Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
| | - Jade Seguin
- Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
| | - Mark O Tessaro
- Paediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
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Marin JR, Lewiss RE. Point-of-care ultrasonography by pediatric emergency physicians. Policy statement. Ann Emerg Med 2016; 65:472-8. [PMID: 25805037 DOI: 10.1016/j.annemergmed.2015.01.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Indexed: 01/10/2023]
Abstract
Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. Pediatric emergency medicine fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for pediatric emergency physicians.
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Zago M, Martinez Casas I, Pereira J, Mariani D, Silva AR, Casamassima A, Barbosa E, Ferreira F, Ruesseler M, Bass GA, Ponchietti L, Butti F, Marconi M, Pinheiro LF. Tailored ultrasound learning for acute care surgeons: a review of the MUSEC (Modular UltraSound ESTES Course) project. Eur J Trauma Emerg Surg 2016; 42:161-8. [DOI: 10.1007/s00068-016-0651-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/10/2016] [Indexed: 01/17/2023]
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Zitek T, Baydoun J, Yepez S, Forred W, Slattery DE. Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis. West J Emerg Med 2016; 17:201-8. [PMID: 26973753 PMCID: PMC4786247 DOI: 10.5811/westjem.2016.1.29335] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/04/2016] [Accepted: 01/10/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Two-point compression ultrasound is purportedly a simple and accurate means to diagnose proximal lower extremity deep vein thrombosis (DVT), but the pitfalls of this technique have not been fully elucidated. The objective of this study is to determine the accuracy of emergency medicine resident-performed two-point compression ultrasound, and to determine what technical errors are commonly made by novice ultrasonographers using this technique. Methods This was a prospective diagnostic test assessment of a convenience sample of adult emergency department (ED) patients suspected of having a lower extremity DVT. After brief training on the technique, residents performed two-point compression ultrasounds on enrolled patients. Subsequently a radiology department ultrasound was performed and used as the gold standard. Residents were instructed to save videos of their ultrasounds for technical analysis. Results Overall, 288 two-point compression ultrasound studies were performed. There were 28 cases that were deemed to be positive for DVT by radiology ultrasound. Among these 28, 16 were identified by the residents with two-point compression. Among the 260 cases deemed to be negative for DVT by radiology ultrasound, 10 were thought to be positive by the residents using two-point compression. This led to a sensitivity of 57.1% (95% CI [38.8–75.5]) and a specificity of 96.1% (95% CI [93.8–98.5]) for resident-performed two-point compression ultrasound. This corresponds to a positive predictive value of 61.5% (95% CI [42.8–80.2]) and a negative predictive value of 95.4% (95% CI [92.9–98.0]). The positive likelihood ratio is 14.9 (95% CI [7.5–29.5]) and the negative likelihood ratio is 0.45 (95% CI [0.29–0.68]). Video analysis revealed that in four cases the resident did not identify a DVT because the thrombus was isolated to the superior femoral vein (SFV), which is not evaluated by two-point compression. Moreover, the video analysis revealed that the most common mistake made by the residents was inadequate visualization of the popliteal vein. Conclusion Two-point compression ultrasound does not identify isolated SFV thrombi, which reduces its sensitivity. Moreover, this technique may be more difficult than previously reported, in part because novice ultrasonographers have difficulty properly assessing the popliteal vein.
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Affiliation(s)
- Tony Zitek
- University of Nevada School of Medicine, Department of Emergency Medicine, Reno, Nevada; University Medical Center of Southern Nevada, Department of Emergency Medicine, Las Vegas, Nevada
| | - Jamie Baydoun
- University of Nevada School of Medicine, Department of Emergency Medicine, Reno, Nevada; University Medical Center of Southern Nevada, Department of Emergency Medicine, Las Vegas, Nevada
| | - Salvador Yepez
- University Medical Center of Southern Nevada, Department of Emergency Medicine, Las Vegas, Nevada
| | - Wesley Forred
- University Medical Center of Southern Nevada, Department of Emergency Medicine, Las Vegas, Nevada
| | - David E Slattery
- University of Nevada School of Medicine, Department of Emergency Medicine, Reno, Nevada; University Medical Center of Southern Nevada, Department of Emergency Medicine, Las Vegas, Nevada
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Chandra A, Zerzan J, Arroyo A, Levine M, Dickman E, Tessaro M. Point-of-care ultrasound in pediatric urolithiasis: an ED case series. Am J Emerg Med 2015; 33:1531-4. [DOI: 10.1016/j.ajem.2015.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022] Open
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What Is the Accuracy of Emergency Physician–Performed Ultrasonography for Deep Venous Thrombosis? Ann Emerg Med 2015; 65:699-701. [DOI: 10.1016/j.annemergmed.2014.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 06/23/2014] [Accepted: 06/27/2014] [Indexed: 11/20/2022]
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Henneberry RJ, Hanson A, Healey A, Hebert G, Ip U, Mensour M, Mikhail P, Miller S, Socransky S, Woo M. Use of point of care sonography by emergency physicians. CAN J EMERG MED 2015; 14:106-12. [DOI: 10.2310/8000.caepps] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Lewiss RE, Kaban NL, Saul T. Point-of-Care Ultrasound for a Deep Venous Thrombosis. Glob Heart 2015; 8:329-33. [PMID: 25690634 DOI: 10.1016/j.gheart.2013.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/04/2013] [Indexed: 12/27/2022] Open
Abstract
Patients presenting to the emergency department with lower extremity symptoms suggestive of venous thromboembolic disease require a diagnostic evaluation. Although contrast venography was the diagnostic standard, this has largely been replaced by duplex ultrasound as the first-line imaging modality. This review presents a summary of the literature on the evolution and performance of B-mode point-of-care compression ultrasound as an alternative to duplex ultrasound evaluation. The 2-point compression and 2-region compression techniques are described. The limitations of point-of-care ultrasound of the lower extremity as a diagnostic modality for this disease entity, the role of a D-dimer assay in the emergency department evaluation and future directions for this diagnostic modality are discussed.
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Affiliation(s)
- Resa E Lewiss
- Department of Emergency Medicine, St. Luke's/Roosevelt Hospital Center, New York, NY, USA.
| | - Nicole L Kaban
- Department of Emergency Medicine, St. Luke's/Roosevelt Hospital Center, New York, NY, USA
| | - Turandot Saul
- Department of Emergency Medicine, St. Luke's/Roosevelt Hospital Center, New York, NY, USA
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Abstract
Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.
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Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi. J Vasc Surg Venous Lymphat Disord 2015; 3:184-9. [DOI: 10.1016/j.jvsv.2014.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/23/2014] [Indexed: 01/01/2023]
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Dickman E, Tessaro MO, Arroyo AC, Haines LE, Marshall JP. Clinician-performed abdominal sonography. Eur J Trauma Emerg Surg 2015; 41:481-92. [PMID: 26038027 DOI: 10.1007/s00068-015-0508-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Point-of-care ultrasonography is increasingly utilized across a wide variety of physician specialties. This imaging modality can be used to evaluate patients rapidly and accurately for a wide variety of pathologic conditions. METHODS A literature search was performed for articles focused on clinician-performed ultrasonography for the diagnosis of appendicitis, gallbladder disease, small bowel obstruction, intussusception, and several types of renal pathology. The findings of this search were summarized including the imaging techniques utilized in these studies. CONCLUSION Clinician performed point-of-care sonography is particularly well suited to abdominal applications. Future investigations may further confirm and extend its utility at the bedside.
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Affiliation(s)
- E Dickman
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA.
| | - M O Tessaro
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - A C Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
| | - L E Haines
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
| | - J P Marshall
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, 11219, USA
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Wang L, Kang W, Zu M, Zhang Q, Shen J, Wu L, Wang D. Application of 128-slice spiral CT combination scanning in the diagnosis of embolisms in pulmonary arteries and lower extremity veins. Exp Ther Med 2013; 7:401-404. [PMID: 24396414 PMCID: PMC3881061 DOI: 10.3892/etm.2013.1424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/11/2013] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to evaluate the significance of using multi-row spiral computed tomography (CT) to scan for pulmonary artery thrombosis and lower limb deep vein thrombosis (LVT) in patients with suspected LVT. A total of 110 patients underwent a contrast-enhanced spiral CT inspection of the pulmonary artery and lower extremity veins. Three-dimensional digital image processing, including multi-planar reconstruction (MPR), maximum intensity projection (MIP) and volume rendering (VR), was also conducted; two groups of experienced radiologists analyzed the CT images to evaluate the postprocessing techniques of these CT images. Seventy-five patients were diagnosed with LVT with or without pulmonary embolism (PE); out of these 75, 34 patients were diagnosed with PE and LVT together and 41 patients were diagnosed with LVT alone. A further 31 patients were diagnosed with iliac vein compression syndrome (IVCS), and no embolisms were detected in the remaining four patients. With regard to PE, MPR and MIP demonstrated an accuracy of 100%, while MPR also showed images of LVT with an accuracy of 100%. The follow-up results at 12 months were consistent with the CT scan results. The clinical use of 128-slice spiral CT combination scanning in the detection of PE and LVT has significant potential to improve upon the present methods of diagnosis.
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Affiliation(s)
- Linyou Wang
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
| | - Wugen Kang
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
| | - Maoheng Zu
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
| | - Qingqiao Zhang
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
| | - Jianmin Shen
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
| | - Liang Wu
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
| | - Dongguo Wang
- Department of Radiology and Intervention, Municipal Hospital of Taizhou, Taizhou, Zhejiang 318000, P.R. China
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Crowhurst TD, Dunn RJ. Sensitivity and specificity of three-point compression ultrasonography performed by emergency physicians for proximal lower extremity deep venous thrombosis. Emerg Med Australas 2013; 25:588-96. [DOI: 10.1111/1742-6723.12155] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas D Crowhurst
- School of Medicine; Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
| | - Robert J Dunn
- Discipline of Acute Care Medicine; School of Medicine; Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
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Bramante RM, Raio CC. Near-Miss in Focused Lower-Extremity Ultrasound for Deep Venous Thrombosis. J Emerg Med 2013; 45:236-9. [DOI: 10.1016/j.jemermed.2012.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 06/04/2012] [Accepted: 11/06/2012] [Indexed: 10/27/2022]
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Ng WF, Stangroom A, Davidson A, Wilton K, Mitchell S, Newton J. Primary Sjogrens syndrome is associated with impaired autonomic response to orthostasis and sympathetic failure. QJM 2012; 105:1191-9. [PMID: 22976617 PMCID: PMC3508582 DOI: 10.1093/qjmed/hcs172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Symptoms in keeping with autonomic dysfunction are commonly described by primary Sjögrens syndrome patients (pSS); whether objective abnormalities of autonomic function occur is unclear. This study set out to explore dynamic cardiovascular autonomic responses in pSS and their relationship with symptoms and quality of life. METHODS Twenty-one people from the UK pSS registry, 21 community controls and 21 patients with the autoimmune liver disease primary biliary cirrhosis (PBC) (matched case-wise for age and sex) attended for assessment of autonomic responses to orthostasis and Valsalva manoeuvre (VM). pSS patients also completed EULAR Sjögrens Syndrome patient-reported index (ESSPRI), EULAR Sjögren's syndrome disease activity index (ESSDAI), fatigue impact scale and EURO-QOL 5-dimension (EQ-5D). RESULTS Compared with controls, pSS patients had significantly lower baseline systolic blood pressure (SBP) (114 ± 13 vs. 127 ± 20; P = 0.02), which dropped to a significantly lower value (98 ± 22 vs. 119 ± 24, P = 0.009). When area under the curve (AUC) was calculated for when the SBP was below baseline this was significantly greater in pSS compared to both control groups (pSS vs. control vs. PBC: 153 ± 236 vs. 92 ± 85 vs. 1.2 ± 0.3, P = 0.005). Peak phase IV SBP during the VM was significantly lower in pSS (P = 0.007) indicating early sympathetic failure. Increased heart rate associated with fatigue (P = 0.02; r(2) = 0.2) and EQ-5D. A shift in sympathetic-vagal balance associated with overall symptom burden (ESSPRI) (P = 0.04, r(2) = 0.3) and EULAR sicca score (P = 0.016; r(2) = 0.3), the latter also correlated with baroreceptor effectiveness (P = 0.03; r(2) = 0.2) and diastolic blood pressure variability (P = 0.003; r(2) = 0.4). CONCLUSION pSS patients have impaired blood pressure response to standing. Dysautonomia correlates with PSS-associated symptoms and quality of life.
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Affiliation(s)
- W.-F. Ng
- From the Institute of Cellular Medicine and Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing Health, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle Upon Tyne NE2 4HH, UK
| | - A.J. Stangroom
- From the Institute of Cellular Medicine and Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing Health, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle Upon Tyne NE2 4HH, UK
| | - A. Davidson
- From the Institute of Cellular Medicine and Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing Health, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle Upon Tyne NE2 4HH, UK
| | - K. Wilton
- From the Institute of Cellular Medicine and Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing Health, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle Upon Tyne NE2 4HH, UK
| | - S. Mitchell
- From the Institute of Cellular Medicine and Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing Health, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle Upon Tyne NE2 4HH, UK
| | - J.L. Newton
- From the Institute of Cellular Medicine and Institute of Ageing and Health and NIHR Biomedical Research Centre for Ageing Health, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle Upon Tyne NE2 4HH, UK
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Michalke JA. An overview of emergency ultrasound in the United States. World J Emerg Med 2012; 3:85-90. [PMID: 25215044 PMCID: PMC4129790 DOI: 10.5847/wjem.j.issn.1920-8642.2012.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/20/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As emergency ultrasound use explodes around the world, it is important to realize the path its development has taken and learn from trials and tribulations of early practitioners in the field. METHODS Approaches to education, scanning, documentation, and organization are also described. RESULTS Machines have reduced in price and once purchased further material costs are low. Staffing costs in terms of training, etc have yet to be assessed, but indications from elsewhere are that these are low. Length of stay in the emergency department dramatically decreases, thus increasing patient satisfaction while maintaining an even higher standard of care. CONCLUSION Emergency screening ultrasound is now a nationally accepted tool for the rapid assessment of the emergency patient.
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Affiliation(s)
- Jeremy A. Michalke
- Emergency Ultrasound, Upper Chesapeake Health System, Bel Air, MD 21014, USA
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Sippel S, Muruganandan K, Levine A, Shah S. Review article: Use of ultrasound in the developing world. Int J Emerg Med 2011; 4:72. [PMID: 22152055 PMCID: PMC3285529 DOI: 10.1186/1865-1380-4-72] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 12/07/2011] [Indexed: 01/17/2023] Open
Abstract
As portability and durability improve, bedside, clinician-performed ultrasound is seeing increasing use in rural, underdeveloped parts of the world. Physicians, nurses and medical officers have demonstrated the ability to perform and interpret a large variety of ultrasound exams, and a growing body of literature supports the use of point-of-care ultrasound in developing nations. We review, by region, the existing literature in support of ultrasound use in the developing world and training guidelines currently in use, and highlight indications for emergency ultrasound in the developing world. We suggest future directions for bedside ultrasound use and research to improve diagnostic capacity and patient care in the most remote areas of the globe.
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Affiliation(s)
- Stephanie Sippel
- Department of Emergency Medicine, Brown University, 593 Eddy Street, Providence RI, 02903, USA.
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Barillari A, Barillari G, Pasca S. Extended Compression Ultrasound Performed by Emergency Physicians: A Modified Compression Ultrasound Examination to Detect Superficial and Deep Lower Limb Thromboses in the Emergency Department. J Med Ultrasound 2011. [DOI: 10.1016/j.jmu.2011.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Theodoro D. In Reply. Acad Emerg Med 2011. [DOI: 10.1111/j.1553-2712.2011.01023.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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