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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] [What about the content of this article? (0)] [Affiliation(s)] [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:e115-55. [PMID: 37596025 DOI: 10.1016/j.annemergmed.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Adhikari S, Leo M, Liu R, Johnston M, Keehbauch J, Barton M, Kendall J. The 2023 Core Content of advanced emergency medicine ultrasonography. J Am Coll Emerg Physicians Open 2023; 4:e13015. [PMID: 37564703 PMCID: PMC10411060 DOI: 10.1002/emp2.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
In February 2023, the American Board of Emergency Medicine (ABEM) approved modifications to the Advanced Emergency Medicine Ultrasonography (AEMUS) Core Content, which defines the areas of knowledge considered essential for the practice of AEMUS. This manuscript serves as a revision of the AEMUS Core Content originally published in 2014. The revision of the Core Content for AEMUS training aims to establish standardized education and qualifications necessary for AEMUS fellowship program leadership, clinical application, administration, quality improvement, and research. The Core Content provides the organizational framework and serves as the basis for the development of content for the Focused Practice Examination (FPE) administered by ABEM. AEMUS fellowship directors may reference the Core Content when designing AEMUS fellowship curricula to help prepare graduates for the autonomous practice of AEMUS and the FPE. In this article, an updated revision of the previously published AEMUS Core Content is detailed, and the entire development of the Core Content is presented.
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Affiliation(s)
- Srikar Adhikari
- Department of Emergency MedicineUniversity of ArizonaTucsonArizonaUSA
| | - Megan Leo
- Department of Emergency MedicineBoston Medical CenterBostonMassachussetsUSA
| | - Rachel Liu
- Department of Emergency MedicineYale UniversityNew HavenConnecticutUSA
| | - Mary Johnston
- American Board of Emergency MedicineEast LansingMichiganUSA
| | | | - Melissa Barton
- American Board of Emergency MedicineEast LansingMichiganUSA
| | - John Kendall
- Department of Emergency MedicineDenver Health Medical CenterDenverColoradoUSA
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Joyce L, Loubser J, de Ryke R, McHaffie A. Young female with abdominal pain and intra-abdominal free fluid: The risk of confirmation bias associated with point-of-care ultrasound. Australas J Ultrasound Med 2022; 25:207-209. [PMID: 36405791 PMCID: PMC9644439 DOI: 10.1002/ajum.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Confirmation bias is an ever-present risk to the rapid decision-making required in emergency departments (EDs). We present a case of a young woman who was brought to ED by ambulance with hypotension, syncope and vaginal bleeding, with a presumptive pre-hospital diagnosis of ruptured ectopic pregnancy. On arrival in ED, she was found to have intra-abdominal free fluid on bedside ultrasound. This finding could have been used by clinicians to confirm their suspicion of a ruptured ectopic; however, with further investigations, it was found that anaphylaxis was the most likely cause of the patient's symptoms. This case highlights that point-of-care ultrasound findings can play a potentially dangerous role in confirmation bias and that we should maintain an open mind when making a diagnosis by treating the patient, rather than the ultrasound picture.
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Affiliation(s)
- Laura Joyce
- Department of SurgeryUniversity of Otago (Christchurch)ChristchurchNew Zealand
- Emergency DepartmentTe Whatu Ora ‐ WaitahaChristchurchNew Zealand
| | - Jacques Loubser
- Emergency DepartmentTe Whatu Ora ‐ WaitahaChristchurchNew Zealand
| | - Rex de Ryke
- Department of RadiologyTe Whatu Ora ‐ WaitahaChristchurchNew Zealand
| | - Alexandra McHaffie
- Department of RadiologyTe Whatu Ora ‐ WaitahaChristchurchNew Zealand
- Department of RadiologyUniversity of Otago (Christchurch)ChristchurchNew Zealand
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Çelik A, Yazıcı MM, Oktay M. The impact of high-frequency linear transducer on the accuracy of pelvic ultrasound in early pregnancy pelvic pain and bleeding. Am J Emerg Med 2022; 61:105-110. [DOI: 10.1016/j.ajem.2022.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 10/31/2022] Open
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Cohen A, Shi D, Keraney E, Stankard B, Nelson M. Ultrasound in the Emergency Department Identifies Ectopic Pregnancy Post Hysterectomy: A Case Report. Clin Pract Cases Emerg Med 2022; 6:129-132. [PMID: 35701342 PMCID: PMC9197750 DOI: 10.5811/cpcem.2022.2.54929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Ruptured ectopic pregnancy is one of the leading causes of maternal death. Point-of-care ultrasound (POCUS) has been shown to be highly sensitive for excluding ectopic pregnancy. Ectopic pregnancy after a hysterectomy is a rare but life-threatening occurrence. We present a case where POCUS helped to diagnose a post-hysterectomy ectopic pregnancy. Case report A 36-year-old female with a prior surgical history of hysterectomy without oophorectomy presented to the emergency department with lower abdominal pain. A POCUS revealed free fluid in the right upper quadrant with an unremarkable gallbladder. Subsequently, the pelvic POCUS noted free fluid as well as a heterogeneous structure in the right adnexa. The clinician ordered a serum beta human chorionic gonadotropin level, which was 173.2 international units per milliliter (lU/mL) (negative: < 5m IU/ml). Transvaginal ultrasound revealed a right adnexal echogenic structure with surrounding vascularity and moderate, complex free fluid suggestive of hemorrhage. Given the concern for possible ectopic pregnancy, obstetrics took the patient to the operating room where a right tubal ectopic pregnancy was confirmed. Conclusion A ruptured ectopic pregnancy is a life-threatening condition that requires rapid diagnosis. Ectopic pregnancy post hysterectomy is an uncommon occurrence infrequently considered in the differential diagnosis of lower abdominal pain, leading to considerable delays in diagnosis. Although uncommon, emergency clinicians must consider this diagnosis in female patients with lower abdominal pain.
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Affiliation(s)
- Allison Cohen
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Dorothy Shi
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Evan Keraney
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Brendon Stankard
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
| | - Matthew Nelson
- North Shore University Hospital, Department of Emergency Medicine, Manhasset, New York
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Ienghong K, Cheung LW, Tiamkao S, Bhudhisawasdi V, Apiratwarakul K. Integrating Point of Care Ultrasound Education into Clinical Practice at the Emergency Department. Tomography 2022; 8:1052-9. [PMID: 35448719 PMCID: PMC9028775 DOI: 10.3390/tomography8020085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022] Open
Abstract
Point of care ultrasound (POCUS) competency is now required learning for emergency medicine trainees. However, there is a wide range of areas that need to be assessed when determining competence. Therefore, this study aims to evaluate competence levels of POCUS skill acquisition including the areas of image acquisition, image interpretation and clinical integration of the emergency medicine residents while on shift in real clinical practice situations. This was a retrospective descriptive study. This study was conducted at Srinagarind Hospital, Thailand from January 2021 through December 2021. The data were collected and reviewed from electronic medical records, ultrasound images and video clips. All POCUS competency skills were assessed by researcher staff. Our results demonstrated that our learners had overall satisfactory competence of image acquisition, satisfactory image interpretation skills, and good clinical integration skills. However, obstetrics and gynecology (OB-GYN) ultrasound scores were poor and cardiac ultrasound had the most varied score of image quality. This study clearly showed the measurable benefits of a POCUS course being integrated into real clinical practice.
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Hashim A, Tahir MJ, Ullah I, Asghar MS, Siddiqi H, Yousaf Z. The utility of point of care ultrasonography (POCUS). Ann Med Surg (Lond) 2021; 71:102982. [PMID: 34840746 PMCID: PMC8606703 DOI: 10.1016/j.amsu.2021.102982] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ahmed Hashim
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | | | - Haziq Siddiqi
- University of California, San Francisco, United States
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9
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Urquhart S, Barnes M, Flannigan M. Comparing Time to Diagnosis and Treatment of Patients with Ruptured Ectopic Pregnancy Based on Type of Ultrasound Performed: A Retrospective Inquiry. J Emerg Med 2021; 62:200-206. [PMID: 34538680 DOI: 10.1016/j.jemermed.2021.07.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/30/2021] [Accepted: 07/31/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hemorrhage from ruptured ectopic pregnancy is the leading cause of first trimester mortality in North America. OBJECTIVES Our objective was to compare patients with a ruptured ectopic pregnancy who had an emergency department (ED) point-of-care ultrasound (PoCUS) with those who received a radiology department-performed ultrasound (RADUS). Four time intervals were measured: ED arrival to ultrasound interpretation, obstetric consultation, operating room (OR) arrival, and ultrasound interpretation to OR arrival. METHODS This was a retrospective cohort study of patients with ruptured ectopic pregnancy seen between February 2012 and September 2018 at an urban tertiary care hospital. Patients who received an ultrasound in the ED, went directly to the OR, and had confirmed rupture were included. RESULTS Of 262 patients diagnosed with ectopic pregnancy during the study period, 36 (14%) were ruptured and 32 were enrolled. Comparing times between PoCUS (n = 10) and RADUS (n = 22) groups, the mean time from ED arrival to ultrasound interpretation was 15 vs. 138 min (difference 123, 95% confidence interval [CI] 88-158), from ED arrival to obstetric consultation was 35 vs. 150 min (difference 115, 95% CI 59-171), from ED arrival to OR arrival was 160 vs. 381 min (difference 222, 95% CI 124-320), and from ultrasound interpretation to OR arrival was 145 vs. 243 min (difference 98, 95% CI 12-184). CONCLUSION ED patients with a ruptured ectopic pregnancy who received a PoCUS first had shorter times to diagnosis, obstetric consultation, and OR arrival compared with those who received RADUS.
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Affiliation(s)
- Sara Urquhart
- Michigan State University College of Human Medicine, Grand Rapids, Michigan.
| | - Mariah Barnes
- Department of Emergency Medicine, Spectrum Health, Grand Rapids, Michigan
| | - Matthew Flannigan
- Department of Emergency Medicine, Spectrum Health, Grand Rapids, Michigan
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10
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Chisolm‐Straker M, Quest T, Kline JA. AEM special issue on (in)equity in emergency medicine. Acad Emerg Med 2021; 28:946-948. [PMID: 34363646 DOI: 10.1111/acem.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
The year of 2020 was a momentous one for the United States. A confluence of purposely-designed systems' outcomes and deep histories of schism converged with a viral mutation to force the topic of (in)justice to re-enter mainstream conversation. Not since the Civil Rights Movement has the matter of (in)equity been in the homes of so many U.S. families and the (virtual) offices of so many workplaces. The disproportionate deaths of Indigenous, Black, Asian, and Latinx peoples in relation to Whites is long-known in communities of color and is well documented in public health.
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Affiliation(s)
- Makini Chisolm‐Straker
- Emergency Medicine Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Tammie Quest
- Division of Palliative Medicine Emergency Medicine Emory Palliative Care Center Emory University School of Medicine Atlanta Georgia USA
| | - Jeffrey A. Kline
- Emergency Medicine Wayne State University School of Medicine Detroit Michigan USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Moake MM, Price AB, Titus MO, Barnes RM. Point-of-Care Ultrasound Facilitates Management of Ruptured Ectopic Pregnancy. Pediatr Emerg Care 2021; 37:282-285. [PMID: 33903289 DOI: 10.1097/pec.0000000000002375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Abdominal pain in the pregnant adolescent presents a diagnostic dilemma with potential life-threatening etiologies. We present a case where point-of-care ultrasound was used to facilitate diagnosis and expedite lifesaving management of a ruptured ectopic pregnancy. We further review the technique and literature for first-trimester transabdominal point-of-care ultrasound.
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Affiliation(s)
| | | | | | - Ryan M Barnes
- Emergency Medicine, Medical University of South Carolina, Charleston, SC
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13
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Recker F, Weber E, Strizek B, Gembruch U, Westerway SC, Dietrich CF. Point-of-care ultrasound in obstetrics and gynecology. Arch Gynecol Obstet 2021; 303:871-876. [PMID: 33558990 PMCID: PMC7985120 DOI: 10.1007/s00404-021-05972-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The rapid technical development and portability of ultrasound systems over recent years has had a profound impact on the area of point-of-care-ultrasound (POCUS), both in general medicine and in obstetrics and gynecology. The use of POCUS enables the clinician to perform the ultrasound scan either at the medical office or the patient's bedside and used as an extension of the physical examination. Real-time images can immediately be correlated with the patient's symptoms, and any changes in a (critical) patient's condition can be more rapidly detected. POCUS IN OBGYN POCUS is also suitable for time-critical scenarios, and depending on the situation and its dynamics, the course and results of any therapy may be observed in real time. POCUS should be considered to be a routine extension of practice for most OB/GYN clinicians as it can give immediate answers to what could be life-threatening situations for the mother and/or baby. With its proven usefulness, the applications and use of POCUS should be incorporated in teaching programs for medical students, OBGYN residents and emergency physicians.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Eva Weber
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | | | - Christoph F Dietrich
- Department for Internal Medicine, Clinic Beau-Site, Schänzlihalde 11, 3013, Bern, Switzerland
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Abstract
Ultrasound has been described as the "stethoscope" of the radiologist; its ability to aid in clinical diagnosis with both static and dynamic imaging has allowed fast and accurate diagnosis. However, traditionally unlike a stethoscope, a large and bulky ultrasound machine made it difficult to use portably in a hospital environment where patients can be scattered across a hospital. With the development of innovative ultrasound technology, Point of Care Ultrasound (PoCUS) can readily be carried by a clinician to make a quick and timely diagnosis. In this review article we look at the uses of PoCUS within orthopaedic emergencies. Diagnosis in orthopaedics often requires further imaging beyond history taking, clinical examination and plain radiographs. In these cases PoCUS can be useful for ruling out occult fractures, diagnosing joint effusions and tendon ruptures. By aiding a speedy diagnosis, we can reduce unnecessary immobilisation, reduce inpatient stays, introduce early mobilisation and reduce harm to patients. With PoCUS becoming increasingly cheaper and more portable we feel this really can become the stethoscope of an orthopaedic surgeon.
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Affiliation(s)
- Jennifer Oluku
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | - Attila Stagl
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | | | - Karmen El-Raheb
- Trauma and Orthopaedic Surgery, Queen Elizabeth Hospital, London, GBR
| | - Richard Beese
- Clinical Radiology, Queen Elizabeth Hospital, London, GBR
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Kodaira Y, Pisani L, Boyle S, Olumide S, Orsi M, Adeniji AO, Pisani E, Zanette M, Putoto G, Koroma MM. Reliability of ultrasound findings acquired with handheld apparatuses to inform urgent obstetric diagnosis in a high-volume resource-limited setting. Int J Gynaecol Obstet 2020; 153:280-286. [PMID: 33159814 DOI: 10.1002/ijgo.13475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/03/2020] [Accepted: 11/05/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the reliability of obstetric handheld smartphone-based point-of-care ultrasound (POCUS) in a resource-limited high-volume setting. METHODS A single-center prospective observational study among women requiring urgent diagnosis and admitted to a maternity referral hospital in Sierra Leone from March to April 2019. Pre-specified ultrasound findings were obtained with a handheld POCUS device; a comprehensive ultrasound examination was then performed by an experienced operator using conventional full-feature apparatus. Agreement was assessed by diagnostic accuracy and Cohen κ-statistics. RESULTS Overall, there were 307 participants. The mean aggregated diagnostic accuracy was 95.5% (κ-statistic, 0.90; 95% confidence interval [CI], 0.89-0.93; P < 0.001). Highest accuracy was reported for detecting free fluid collection in the abdominal cavity (100%; κ-statistic, 1.00; 95% CI, 1.00-1.00; P < 0.001). Ultrasound findings obtained with the handheld device for intrauterine pregnancy, fetal heartbeat, cephalic presentation, multifetal pregnancy, and assessment of gestational age based on bi-parietal diameter were highly reliable (agreement, >90%; κ-statistic, >0.80). Detection of low-lying placenta or placenta previa was the least reliable (κ-statistic, 0.53; 95% CI, 0.13-0.93; P < 0.001). CONCLUSION Handheld POCUS findings were found to be reliable for detecting pre-specified urgent obstetric findings in a high-volume resource-limited referral hospital.
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Affiliation(s)
- Yuichi Kodaira
- Department of Obstetrics and Gynecology, Funabashi Central Hospital, Funabashi, Japan.,Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy
| | - Luigi Pisani
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Sonia Boyle
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Salawu Olumide
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Michele Orsi
- Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | | | - Enzo Pisani
- Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy.,Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Marianna Zanette
- Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy.,Princess Christian Maternity Hospital, Freetown, Sierra Leone
| | - Giovanni Putoto
- Section of Operational Research, Doctors with Africa CUAMM, Padova, Italy
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16
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Jones DD, Kummer T, Schoen JC. Ruptured Ectopic Pregnancy with an Intrauterine Device: Case Report and Sonographic Considerations. Clin Pract Cases Emerg Med 2020; 4:559-563. [PMID: 33217272 PMCID: PMC7676810 DOI: 10.5811/cpcem.2020.7.48258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Ectopic pregnancy carries a high morbidity and mortality; patients are at risk for rupture and life-threatening hemorrhage. CASE REPORT We present a rare case of ruptured abdominal ectopic pregnancy in a patient with a well-positioned intrauterine device (IUD) and discuss the diagnostic utility that transabdominal point-of-care ultrasound (POCUS) can have when performed at the bedside. CONCLUSION While pregnancy with an IUD in place is rare, when it is encountered the emergency provider should maintain a high degree of suspicion for extrauterine pregnancy and perform prompt evaluation for hemorrhagic shock using diagnostic POCUS.
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Affiliation(s)
- Derick D. Jones
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic Health System Albert Lea and Austin, Department of Emergency Medicine, Austin, Minnesota
| | - Tobias Kummer
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Jessica C. Schoen
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic Health System Albert Lea and Austin, Department of Emergency Medicine, Austin, Minnesota
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Dwyer S. Emergency physicians are excellent pattern recognisers: No. Emerg Med Australas 2020; 32:858-859. [DOI: 10.1111/1742-6723.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Dwyer
- Emergency Department Hornsby Ku‐ring‐gai Hospital Sydney New South Wales Australia
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Frasure SE, Dearing E, Burke M, Portela M, Pourmand A. Application of Point-of-Care Ultrasound for Family Medicine Physicians for Abdominopelvic and Soft Tissue Assessment. Cureus 2020; 12:e9723. [PMID: 32944442 PMCID: PMC7489446 DOI: 10.7759/cureus.9723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 01/01/2023] Open
Abstract
Point-of-care ultrasound (POCUS) improves both the sensitivity and specificity with which clinicians can make a variety of diagnoses at the bedside from abdominal aortic aneurysm to kidney stones. In outpatient clinics, urgent care centers, and emergency departments, where ultrasound imaging may be delayed by hours or even days, the use of POCUS can be very helpful. We believe that POCUS facilitates both the triage of patients and provides diagnostic information quickly. We hope to advance the use of POCUS in the primary care setting and have reviewed six sonographic topics where we believe ultrasound can be of immense assistance to the physician in the outpatient setting.
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Affiliation(s)
- Sarah E Frasure
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Elizabeth Dearing
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Morgan Burke
- Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Maria Portela
- Primary Care, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
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Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019; 11:31. [PMID: 31749019 PMCID: PMC6868077 DOI: 10.1186/s13089-019-0145-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. METHODS Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. RESULTS On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. CONCLUSION Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.
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Affiliation(s)
- Bjarte Sorensen
- Hjelmeland General Practice Surgery, Prestagarden 13, 4130, Hjelmeland, Norway.
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
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Thakur U, Atmuri K, Borozdina A. Acute pelvic pain following miscarriage heterotopic pregnancy must be excluded: case report. BMC Emerg Med 2019; 19:59. [PMID: 31653205 PMCID: PMC6814984 DOI: 10.1186/s12873-019-0268-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Heterotopic pregnancies are increasing in prevalence and this case highlights the importance of excluding the diagnosis in patients with pelvic pain following miscarriage. A known pre-existing intrauterine pregnancy can be falsely reassuring and delay the diagnosis of a potentially life-threatening concurrent ectopic pregnancy. Case presentation In this report, we describe a case of spontaneous heterotopic pregnancy in a woman who had initially presented with pelvic pain and vaginal bleeding, and was diagnosed on pelvic ultrasound with a missed miscarriage; a non-viable intrauterine pregnancy. She re-presented 7 days later with worsening pelvic pain and bleeding, and a repeat pelvic ultrasound identified a ruptured tubal ectopic pregnancy in addition to an incomplete miscarriage of the previously identified intrauterine pregnancy. She underwent an emergency laparoscopy where a ruptured tubal ectopic pregnancy was confirmed. Conclusion Being a time critical diagnosis with the potential for an adverse outcome, it is important that the emergency physician considers heterotopic pregnancy as a differential diagnosis in patients presenting with pelvic pain following a recent miscarriage. The same principle should apply to pelvic pain in the context of a known viable intrauterine pregnancy or recent termination of pregnancy. A combination of clinical assessment, beta human chorionic gonadotropin levels, point of care ultrasound and formal transvaginal ultrasound must be utilized together in these situations to explicitly exclude heterotopic pregnancy.
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Affiliation(s)
- Udit Thakur
- School of Public Health and Community Medicine, University of New South Wales, Kensington, New South Wales, Australia. .,Monash Health, Clayton, Victoria, Australia.
| | - Kiran Atmuri
- Royal Women's Hospital, Parkville, Victoria, Australia
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Abstract
PURPOSE Over the past 10 years, successful ultrasound integration into medical education has resulted in 8 residencies and 52 undergraduate medical schools requiring ultrasound training for graduation. Physician assistants (PAs) are trained in the medical model, yet very little is known about the integration of ultrasound into their curricula. This study examined how ultrasound is used, if at all, in the PA education curricula. METHODS Physician assistant program directors (PDs) were sent a survey addressing ultrasound integration into their curricula. Questions focused on the use of ultrasound to teach didactic courses and on inclusion of point-of-care ultrasound (POCUS) scanning skills as an adjunct to the physical examination. The survey also asked about students' feelings toward ultrasound integration into the curricula. RESULTS Investigators contacted 201 PDs, and 107 (53.2%) PDs responded. Twenty-five of the respondents (23.4%) reported using ultrasound in the basic sciences. The top 3 reasons for not including ultrasound in preclinical courses were no ultrasound machine, expense, and no faculty trained in ultrasound. Seventy-three of the respondents (68.2%) thought that POCUS scanning skills should be included in the curriculum. More than 83% felt that faculty or adjunct faculty should teach those skills. CONCLUSION This survey demonstrated that there is great interest in integrating ultrasound into the PA curriculum but that many challenges inhibit implementation. Lack of access to ultrasound machines and to trained faculty are the biggest challenges to integrating ultrasound into the PA curriculum. Physician assistant programs face content and competency challenges similar to those that medical schools face, as well as several challenges that are unique to PA education. Future research is needed to address these issues.
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Abdolrazaghnejad A, Rajabpour-Sanati A, Rastegari-Najafabadi H, Ziaei M, Pakniyat A. The Role of Ultrasonography in Patients Referring to the Emergency Department with Acute Abdominal Pain. Adv J Emerg Med 2019; 3:e43. [PMID: 31633098 PMCID: PMC6789065 DOI: 10.22114/ajem.v0i0.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Acute abdominal pain is a common clinical problem in emergency and non-emergency cases accounting for 5 to 10% of all referrals to the emergency department. Studies have indicated that these widely differentiated diagnoses are common to these complaints. Considering the high prevalence of this complaint in the patients and the wide range of its differential diagnosis, this review study was designed and evaluated aiming at investigating the causes of acute abdominal pain with a focus on assessing the position of ultrasound as a diagnostic tool in the emergency department. EVIDENCE ACQUISITION This article was conducted as a narrative review of selected articles from 2005 through 2019. By comparing them, a comprehensive review of ultrasound role was conducted in patients with acute abdominal pain referring to the emergency department. RESULTS In this review study, we attempted to use the articles of the clinical approach, the required laboratory tests, the disadvantages and advantages of each imaging technique, the differential diagnosis for acute abdominal pain according to the location of the pain, and the position of ultrasound as a diagnostic aid tool. Eventually, the proposed protrusion will be considered in dealing with a patient with acute abdominal pain. CONCLUSION Regarding the wide range of causes providing multiple differential diagnosis, as well as the limited time of the health team in the emergency department for diagnostic and therapeutic measures, particularly in time-sensitive clinical conditions, ultrasound offered by emergency medicine specialists as a diagnostic aid is considered to improve the overall diagnosis and treatment of patients, thereby reducing complications.
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Affiliation(s)
- Ali Abdolrazaghnejad
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Hojjat Rastegari-Najafabadi
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Maryam Ziaei
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Abdolghader Pakniyat
- Department of Emergency Medicine, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Beals T, Naraghi L, Grossestreuer A, Schafer J, Balk D, Hoffmann B. Point of care ultrasound is associated with decreased ED length of stay for symptomatic early pregnancy. Am J Emerg Med 2019; 37:1165-1168. [PMID: 30948256 DOI: 10.1016/j.ajem.2019.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Emergency physicians (EP) can accurately rule out ectopic pregnancy with pelvic point of care ultrasound (PPOCUS). Multiple studies have suggested that PPOCUS may decrease length of stay (LOS) for emergency department (ED) patients presenting with early symptomatic pregnancy compared to comprehensive ultrasound (CUS). This systematic review and meta-analysis examines the association between the use of PPOCUS vs CUS and ED LOS. METHODS A systematic review of the literature was performed. Patients with symptomatic early pregnancy receiving EP-performed PPOCUS were compared to patients receiving CUS without PPOCUS. Keywords and search terms were generated for PPOCUS, ED LOS and CUS. Two independent reviewers screened abstracts for inclusion. A third reviewer was used when conflicts arose to gain consensus. Formal bias assessment was performed on included studies. Meta-analysis was carried out, pooling the mean differences between studies using a random-effects model. RESULTS 2980 initial articles were screened, 32 articles underwent detailed review, 8 underwent bias assessment, and 6 were included in the final meta-analysis. There were 836 patients in the study group and 1514 in the control group. All studies showed a decreased LOS in the PPOCUS group with a mean decrease of 73.8 min (95% CI 49.1, 98.6). Two studies not included in the meta-analysis also showed significantly decreased LOS with PPOCUS. CONCLUSION Use of PPOCUS in the evaluation of patients with symptomatic early pregnancy is associated with decreased LOS in patients ultimately diagnosed with intrauterine pregnancy. This review suggests that this finding is generalizable to a variety of practice settings.
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Affiliation(s)
- Tyler Beals
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
| | - Leily Naraghi
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
| | - Anne Grossestreuer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
| | - Jesse Schafer
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
| | - Dan Balk
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
| | - Beatrice Hoffmann
- Beth Israel Deaconess Medical Center, Department of Emergency Medicine, 1 Deaconess Rd, Rosenberg 2, Boston, MA 0215, USA.
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Liu R, Theodoro D, Fields JM, Jones R, Adhikari S, Noble V, Tayal V. Regarding the article entitled "Do emergency physicians rely on point-of-care ultrasound for clinical decision making without additional confirmatory testing?". J Clin Ultrasound 2019; 47:161-162. [PMID: 30762883 DOI: 10.1002/jcu.22637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/22/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Rachel Liu
- ACEP Emergency Ultrasound Section Chair, Yale University School of Medicine, Dept. of Emergency Medicine, New Haven, Connecticut
| | - Daniel Theodoro
- ACEP Emergency Ultrasound Section Chair-Elect, Washington University in St. Louis, Saint Louis, Missouri
| | - J Matthew Fields
- ACEP Emergency Ultrasound Section Immediate Past Chair, Kaiser Permanente San Diego, San Diego, California
| | - Robert Jones
- ACEP Emergency Ultrasound Section Past Chair, MetroHealth Medical Center, Cleveland, Ohio
| | - Srikar Adhikari
- ACEP Emergency Ultrasound Section Research Committee Chair, University of Arizona Health Sciences Medical Center Tucson, Tucson, Arizona
| | - Vicki Noble
- ACEP Emergency Ultrasound Section Past Chair, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vivek Tayal
- ACEP Emergency Ultrasound Section Past Chair, Carolinas Medical Center, Charlotte, North Carolina
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Moussa M, Stausmire J. Reply by Authors. J Clin Ultrasound 2019; 47:163-164. [PMID: 30762881 DOI: 10.1002/jcu.22713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Mohamad Moussa
- University of Toledo Medical Center, Department of Emergency Medicine, Toledo, Ohio
| | - Julie Stausmire
- Mercy HEalth St. Vincent Medical Center Emergency Department, Regional Academic Affairs/Research, Toledo, Ohio
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Morgan BB, Kao A, Trent SA, Hurst N, Oliveira L, Austin AL, Kendall JL. Effect of Emergency Physician-Performed Point-of-Care Ultrasound and Radiology Department-Performed Ultrasound Examinations on the Emergency Department Length of Stay Among Pregnant Women at Less Than 20 Weeks' Gestation. J Ultrasound Med 2018; 37:2497-2505. [PMID: 29574878 DOI: 10.1002/jum.14607] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/09/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We sought to confirm retrospective studies that measured an approximately 20% reduction in emergency department (ED) length of stay (LOS) in early-gestation pregnant women who receive emergency physician-performed point-of-care ultrasound (US) examinations rather than radiology department-performed US examinations for evaluation of intrauterine pregnancy (IUP). METHODS A randomized controlled clinical trial was performed at an urban academic safety net hospital and 2 Naval medical centers in the United States. The allocation was concealed before enrollment. Clinically stable adult pregnant women at less than 20 weeks' gestation who presented to the ED with abdominal pain or vaginal bleeding were randomized to receive a point-of-care or radiology US to assess for IUP. The primary outcome measure was the ED LOS. RESULTS A total of 224 patients (point-of-care US, n = 118; radiology US, n = 106) were included for the analysis. The ED LOS was 20 minutes shorter in the point-of-care US arm (95% confidence interval [CI], -54 to 7 minutes). Adjusting for variability due to the location, the ED LOS was calculated to be 31 minutes shorter (95% CI, -64 to 1 minute) than for patients in the radiology US arm. Excluding patients in the point-of-care US arm who crossed over to radiology US after an inconclusive point-of-care US examination, the ED LOS was 75 minutes shorter than in the radiology US arm (95% CI, -97 to -53 minutes). CONCLUSIONS Early-gestation pregnant ED patients requiring pelvic US were discharged earlier when point-of-care US was used rather than radiology US; however, this trial did not achieve our target of 30 minutes. Nevertheless, our data support the routine use of ED point-of-care US for IUP, saving the most time if a conclusive IUP is identified.
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Affiliation(s)
- Brian B Morgan
- Department of Emergency Medicine, Rose Medical Center, Denver, Colorado, USA
| | - Amanda Kao
- Department of Emergency Medicine, Lutheran Medical Center, Denver, Colorado, USA
| | - Stacy A Trent
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nicole Hurst
- Department of Emergency Medicine, Naval Medical Center, San Diego, California, USA
| | - Lauren Oliveira
- Department of Emergency Medicine, Naval Medical Center, Portsmouth, Virginia, USA
| | - Andrea L Austin
- Department of Emergency Medicine, Naval Medical Center, San Diego, California, USA
| | - John L Kendall
- Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
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Kozaci N, Avci M, Tulubas G, Ararat E, Karakoyun OF, Karaman C, Erol B. Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918808115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.
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Affiliation(s)
- Nalan Kozaci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Mustafa Avci
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Gul Tulubas
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Ertan Ararat
- Department of Emergency Medicine, Uşak University Education and Research Hospital, Uşak, Turkey
| | - Omer Faruk Karakoyun
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Cagri Karaman
- Department of Emergency Medicine, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
| | - Bekir Erol
- Department of Radiology, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey
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Morton A, Teasdale S. Review article: Investigations and the pregnant woman in the emergency department - part 2: Point-of-care ultrasound, electrocardiography, respiratory function tests and radiology. Emerg Med Australas 2018; 30:749-753. [PMID: 29577627 DOI: 10.1111/1742-6723.12956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 02/07/2018] [Indexed: 12/13/2022]
Abstract
Accurate assessment of the pregnant patient in the ED depends on knowledge of physiological changes in pregnancy, and how these changes may impact on pathology tests, appearance on point-of-care ultrasound, electrocardiography and respiratory function tests. In addition, the emergency physician needs to be cognisant of disorders that are unique to or more common during pregnancy. Part 2 of this review addresses the role of point-of-care ultrasound in pregnancy, physiological changes that may affect interpretation of point-of-care ultrasound, changes in electrocardiography and respiratory function tests, and the safety of radiological procedures in the pregnant patient. Part 1 addressed potential deviations in laboratory investigation reference intervals resulting from physiological alterations in pregnancy and the important causes of abnormal laboratory results in pregnancy.
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Affiliation(s)
- Adam Morton
- Mater Health and The University of Queensland, Brisbane, Queensland, Australia
| | - Stephanie Teasdale
- Mater Health and The University of Queensland, Brisbane, Queensland, Australia
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Hamid AAA, Yousry A, El Radi SA, Shabaan OM, Mazen E, Nabil H. Clinical audit of ectopic pregnancy. Electron Physician 2017; 9:4009-4013. [PMID: 28461878 PMCID: PMC5407236 DOI: 10.19082/4009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/27/2016] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study was to determine the risk factors of ectopic pregnancy in cases presented to the Woman’s Health Hospital (WHH) in Assuit University, and to perform clinical audit on strategies for management of ectopic pregnancy in the WHH. Methods This descriptive hospital based study was conducted at the Woman’s Health Hospital (WHH) of Assuit University (Egypt). There were 210 patients who were admitted to the WHH with the diagnosis of ectopic pregnancy in the period between February 1, 2015 through the end of October 2015. Data were analyzed by SPSS version 21, using descriptive statistics, Mann-Whitney U test, and Chi square. Results Ectopic pregnancy affects woman in the reproductive age. There are many risk factors that increase the chance of its occurrence; however, it may also occur in the absence of any risk factors (14.0%). Internal VD (72.5%) is the most frequent risk factor; other risk factors include history of abortion, previous CS, ovulation induction, history of infertility, or previous history of EP. Conclusion Clinical audit is an important item of any adequate health care. As regards to the clinical audit of EP management, we are not adhering to the guidelines.
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Affiliation(s)
| | - Almraghy Yousry
- Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Assuit Al-Azhar University, Egypt
| | - Safwat Abd El Radi
- Professor of Obstetrics & Gynecology Faculty of Medicine, Assuit University, Egypt
| | - Omar Mamdouh Shabaan
- Professor of Obstetrics & Gynecology Faculty of Medicine, Assuit University, Egypt
| | - Elzahry Mazen
- Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine, Assuit Al-Azhar University, Egypt
| | - Halal Nabil
- Lecturer of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Egypt
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Maurice P, Dhombres F, Blondiaux E, Friszer S, Guilbaud L, Lelong N, Khoshnood B, Charlet J, Perrot N, Jauniaux E, Jurkovic D, Jouannic JM. Towards ontology-based decision support systems for complex ultrasound diagnosis in obstetrics and gynecology. J Gynecol Obstet Hum Reprod 2017; 46:423-429. [PMID: 28934086 DOI: 10.1016/j.jogoh.2017.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/11/2017] [Accepted: 03/22/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION We have developed a new knowledge base intelligent system for obstetrics and gynecology ultrasound imaging, based on an ontology and a reference image collection. This study evaluates the new system to support accurate annotations of ultrasound images. We have used the early ultrasound diagnosis of ectopic pregnancies as a model clinical issue. MATERIAL AND METHODS The ectopic pregnancy ontology was derived from medical texts (4260 ultrasound reports of ectopic pregnancy from a specialist center in the UK and 2795 Pubmed abstracts indexed with the MeSH term "Pregnancy, Ectopic") and the reference image collection was built on a selection from 106 publications. We conducted a retrospective analysis of the signs in 35 scans of ectopic pregnancy by six observers using the new system. RESULTS The resulting ectopic pregnancy ontology consisted of 1395 terms, and 80 images were collected for the reference collection. The observers used the knowledge base intelligent system to provide a total of 1486 sign annotations. The precision, recall and F-measure for the annotations were 0.83, 0.62 and 0.71, respectively. The global proportion of agreement was 40.35% 95% CI [38.64-42.05]. DISCUSSION The ontology-based intelligent system provides accurate annotations of ultrasound images and suggests that it may benefit non-expert operators. The precision rate is appropriate for accurate input of a computer-based clinical decision support and could be used to support medical imaging diagnosis of complex conditions in obstetrics and gynecology.
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Affiliation(s)
- P Maurice
- Inserm U1142 (Limics), UPMC medical faculty (Paris 6), department of fetal medicine, service de médecine fœtale, hôpital Armand-Trousseau, AP-HP, 26, avenue A.-Netter, 75012 Paris, France
| | - F Dhombres
- Inserm U1142 (Limics), UPMC medical faculty (Paris 6), department of fetal medicine, service de médecine fœtale, hôpital Armand-Trousseau, AP-HP, 26, avenue A.-Netter, 75012 Paris, France.
| | - E Blondiaux
- Inserm U1142 (Limics), UPMC medical faculty (Paris 6), department of fetal medicine, service de médecine fœtale, hôpital Armand-Trousseau, AP-HP, 26, avenue A.-Netter, 75012 Paris, France
| | - S Friszer
- Inserm U1142 (Limics), UPMC medical faculty (Paris 6), department of fetal medicine, service de médecine fœtale, hôpital Armand-Trousseau, AP-HP, 26, avenue A.-Netter, 75012 Paris, France
| | - L Guilbaud
- Inserm U1142 (Limics), UPMC medical faculty (Paris 6), department of fetal medicine, service de médecine fœtale, hôpital Armand-Trousseau, AP-HP, 26, avenue A.-Netter, 75012 Paris, France
| | - N Lelong
- Inserm U1153, obstetrical, perinatal and pediatric epidemiology research team, center for biostatistics and epidemiology, 75014 Paris, France
| | - B Khoshnood
- Inserm U1153, obstetrical, perinatal and pediatric epidemiology research team, center for biostatistics and epidemiology, 75014 Paris, France
| | - J Charlet
- Inserm U1142 (Limics), AP-HP DSI, 75006 Paris, France
| | - N Perrot
- Pyramids medical imaging center, 75001 Paris, France
| | - E Jauniaux
- Academic department of obstetrics and gynaecology, gynaecology diagnostic and outpatient treatment unit, university college hospital (UCLH), university college London (UCL), institute for women's health, London, UK
| | - D Jurkovic
- Academic department of obstetrics and gynaecology, gynaecology diagnostic and outpatient treatment unit, university college hospital (UCLH), university college London (UCL), institute for women's health, London, UK
| | - J-M Jouannic
- Inserm U1142 (Limics), UPMC medical faculty (Paris 6), department of fetal medicine, service de médecine fœtale, hôpital Armand-Trousseau, AP-HP, 26, avenue A.-Netter, 75012 Paris, France
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Hahn SA, Promes SB, Brown MD, Brown MD, Byyny R, Diercks DB, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Hatten BW, Haukoos JS, Ingalsbe GS, Kaji A, Kwok H, Lo BM, Mace SE, Nazarian DJ, Proehl JA, Promes SB, Shah KH, Shih RD, Silvers SM, Smith MD, Thiessen ME, Tomaszewski CA, Valente JH, Wall SP, Wolf SJ, Cantrill SV, O’connor RE, Whitson RR. Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy. Ann Emerg Med 2017; 69:241-250.e20. [DOI: 10.1016/j.annemergmed.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Dhombres F, Maurice P, Friszer S, Guilbaud L, Lelong N, Khoshnood B, Charlet J, Perrot N, Jauniaux E, Jurkovic D, Jouannic JM. Developing a knowledge base to support the annotation of ultrasound images of ectopic pregnancy. J Biomed Semantics 2017; 8:4. [PMID: 28137311 PMCID: PMC5282861 DOI: 10.1186/s13326-017-0117-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/18/2017] [Indexed: 11/17/2022] Open
Abstract
Background Ectopic pregnancy is a frequent early complication of pregnancy associated with significant rates of morbidly and mortality. The positive diagnosis of this condition is established through transvaginal ultrasound scanning. The timing of diagnosis depends on the operator expertise in identifying the signs of ectopic pregnancy, which varies dramatically among medical staff with heterogeneous training. Developing decision support systems in this context is expected to improve the identification of these signs and subsequently improve the quality of care. In this article, we present a new knowledge base for ectopic pregnancy, and we demonstrate its use on the annotation of clinical images. Results The knowledge base is supported by an application ontology, which provides the taxonomy, the vocabulary and definitions for 24 types and 81 signs of ectopic pregnancy, 484 anatomical structures and 32 technical elements for image acquisition. The knowledge base provides a sign-centric model of the domain, with the relations of signs to ectopic pregnancy types, anatomical structures and the technical elements. The evaluation of the ontology and knowledge base demonstrated a positive feedback from a panel of 17 medical users. Leveraging these semantic resources, we developed an application for the annotation of ultrasound images. Using this application, 6 operators achieved a precision of 0.83 for the identification of signs in 208 ultrasound images corresponding to 35 clinical cases of ectopic pregnancy. Conclusions We developed a new ectopic pregnancy knowledge base for the annotation of ultrasound images. The use of this knowledge base for the annotation of ultrasound images of ectopic pregnancy showed promising results from the perspective of clinical decision support system development. Other gynecological disorders and fetal anomalies may benefit from our approach.
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Affiliation(s)
- Ferdinand Dhombres
- UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France.
| | - Paul Maurice
- UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France
| | - Stéphanie Friszer
- UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France
| | - Lucie Guilbaud
- UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France
| | - Nathalie Lelong
- INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology), Maternité Port Royal, 53 Avenue de l'Observatoire, 75014, Paris, UE, France
| | - Babak Khoshnood
- INSERM U1153 (Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Biostatistics and Epidemiology), Maternité Port Royal, 53 Avenue de l'Observatoire, 75014, Paris, UE, France
| | - Jean Charlet
- APHP DSI, INSERM U1142 (LIMICS), 15, rue de l'École de Médecine, 75006, Paris, UE, France
| | - Nicolas Perrot
- Pyramides Medical Imaging Center, 13 av. de l'Opéra, 75001, Paris, UE, France
| | - Eric Jauniaux
- University College Hospital (UCLH) Department of Obstetrics and Gynaecology, Academic Department of Obstetrics and Gynaecology, University College London (UCL) Institute for Women's Health, 86-96 Chenies Mews, London, WC1E 6HX, UE, UK
| | - Davor Jurkovic
- Department of Obstetrics and Gynaecology, Gynaecology Diagnostic and Outpatient Treatment Unit, University College Hospital (UCLH), 235 Euston Road, London, NW1 2BU, UE, UK
| | - Jean-Marie Jouannic
- UPMC Medical Faculty (Paris 6), Department of Fetal Medicine in Armand Trousseau Hospital (APHP), INSERM U1142 (LIMICS), 26 Avenue du Dr Arnold Netter, 75012, Paris, UE, France
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Dietrich CF, Goudie A, Chiorean L, Cui XW, Gilja OH, Dong Y, Abramowicz JS, Vinayak S, Westerway SC, Nolsøe CP, Chou YH, Blaivas M. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43:49-58. [PMID: 27472989 DOI: 10.1016/j.ultrasmedbio.2016.06.021] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Over the last decade, the use of portable ultrasound scanners has enhanced the concept of point of care ultrasound (PoC-US), namely, "ultrasound performed at the bedside and interpreted directly by the treating clinician." PoC-US is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid and direct solutions. PoC-US has already revolutionized everyday clinical practice, and it is believed that it will dramatically change how ultrasound is applied in daily practice. However, its use and teaching are different from continent to continent and from country to country. This World Federation for Ultrasound in Medicine and Biology position paper discusses the current status and future perspectives of PoC-US. Particular attention is given to the different uses of PoC-US and its clinical significance, including within emergency and critical care medicine, cardiology, anesthesiology, rheumatology, obstetrics, neonatology, gynecology, gastroenterology and many other applications. In the future, PoC-US will be more diverse than ever and be included in medical student training.
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Affiliation(s)
- Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China.
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
| | - Liliana Chiorean
- Département d'imagerie médicale, Clinique des Cévennes 07100 Annonay, France
| | - Xin Wu Cui
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Sino-German Research Center of Ultrasound in Medicine, First Affiliated Hospital of Zhengzhou University, China
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Yi Dong
- Medical Department, Caritas-Krankenhaus, Bad Mergentheim, Germany; Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jacques S Abramowicz
- Section of Ultrasound, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Sudhir Vinayak
- Department of Imaging & Diagnostic Radiology, WFUMB COE, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Christian Pállson Nolsøe
- Copenhagen Academy for Medical Education and Simulation (CAMES), Ultrasound Section, Department of Gastroenterology, Division of Surgery, Herlev Hospital, University of Copenhagen, Denmark
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Michael Blaivas
- University of South Carolina School of Medicine, Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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 C Riley
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | | | - David Teng
- Cohen Children's Medical Center, New Hyde Park, USA
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Nelson M, Abdi A, Adhikari S, Boniface M, Bramante RM, Egan DJ, Matthew Fields J, Leo MM, Liteplo AS, Liu R, Nomura JT, Pigott DC, Raio CC, Ruskis J, Strony R, Thom C, Lewiss RE. Goal-directed Focused Ultrasound Milestones Revised: A Multiorganizational Consensus. Acad Emerg Med 2016; 23:1274-1279. [PMID: 27520068 DOI: 10.1111/acem.13069] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
In 2012 the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine released the emergency medicine milestones. The Patient Care 12 (PC12) subcompetency delineates staged and progressive accomplishment in emergency ultrasound. While valuable as an initial framework for ultrasound resident education, there are limitations to PC12. This consensus paper provides a revised description of criteria to define the subcompetency. A multiorganizational task force was formed between the American College of Emergency Physicians Ultrasound Section, the Council of Emergency Medicine Residency Directors, and the Academy of Emergency Ultrasound of the Society for Academic Emergency Medicine. Representatives from each organization created this consensus document and revision.
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Affiliation(s)
- Mathew Nelson
- Department of Emergency Medicine; North Shore University Hospital; Plainview NY
| | - Amin Abdi
- Department of Emergency Medicine; Los Angeles County University of Southern California Medical Center; Los Angeles CA
| | - Srikar Adhikari
- Department of Emergency Medicine; University of Arizona; Tucson AZ
| | - Michael Boniface
- Department of Emergency Medicine; University of Florida; Gainesville FL
| | - Robert M. Bramante
- Department of Emergency Medicine; Good Samaritan Hospital Medical Center; Islip NY
| | - Daniel J. Egan
- Department of Emergency Medicine; Mt. Sinai St. Luke's Roosevelt; New York NY
| | - J. Matthew Fields
- Department of Emergency Medicine; Thomas Jefferson Hospital; Philadelphia PA
| | - Megan M. Leo
- Department of Emergency Medicine; Boston University School of Medicine; Boston MA
| | - Andrew S. Liteplo
- Department of Emergency Medicine; Massachusetts General Hospital; Boston MA
| | - Rachel Liu
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Jason T. Nomura
- Department of Emergency Medicine; Christiana Care Health System; Newark DE
| | - David C. Pigott
- Department of Emergency Medicine; University of Alabama at Birmingham; Birmingham AL
| | - Christopher C. Raio
- Department of Emergency Medicine; Good Samaritan Hospital Medical Center; Islip NY
| | - Jennifer Ruskis
- Department of Emergency Medicine; Cook County Hospital; Chicago IL
| | - Robert Strony
- Department of Emergency Medicine; Geisinger Medical Center; Danville PA
| | - Chris Thom
- Department of Emergency Medicine; University of Virginia Health System; Charlottesville VA
| | - Resa E. Lewiss
- Department of Emergency Medicine; University of Colorado School of Medicine; Aurora CO
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Wilson SP, Connolly K, Lahham S, Subeh M, Fischetti C, Chiem A, Aspen A, Anderson C, Fox JC. Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay. World J Emerg Med 2016; 7:178-82. [PMID: 27547276 DOI: 10.5847/wjem.j.1920-8642.2016.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The study aimed to compare the time to overall length of stay (LOS) for patients who underwent point-of-care ultrasound (POCUS) versus radiology department ultrasound (RDUS). METHODS This was a prospective study on a convenience sample of patients who required pelvic ultrasound imaging as part of their emergency department (ED) assessment. RESULTS We enrolled a total of 194 patients who were on average 32 years-old. Ninety-eight (51%) patients were pregnant (<20 weeks). Time to completion of RDUS was 66 minutes longer than POCUS (95%CI 60-73, P<0.01). Patients randomized to the RDUS arm experienced a 120 minute longer ED length of stay (LOS) (95%CI 66-173, P<0.01). CONCLUSION In patients who require pelvic ultrasound as part of their diagnostic evaluation, POCUS resulted in a significant decrease in time to ultrasound and ED LOS.
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Affiliation(s)
- Sean P Wilson
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - Kiah Connolly
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - Shadi Lahham
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - Mohammad Subeh
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - Chanel Fischetti
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - Alan Chiem
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, California 90095, USA
| | - Ariel Aspen
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - Craig Anderson
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
| | - John C Fox
- Department of Emergency Medicine, University of California Irvine, Irvine, California 92697, USA
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Abstract
Point-of-care ultrasonography (POCUS) is a useful imaging technique for the emergency medicine (EM) physician. Because of its growing use in EM, this article will summarize the historical development, the scope of practice, and some evidence supporting the current applications of POCUS in the adult emergency department. Bedside ultrasonography in the emergency department shares clinical applications with critical care ultrasonography, including goal-directed echocardiography, echocardiography during cardiac arrest, thoracic ultrasonography, evaluation for deep vein thrombosis and pulmonary embolism, screening abdominal ultrasonography, ultrasonography in trauma, and guidance of procedures with ultrasonography. Some applications of POCUS unique to the emergency department include abdominal ultrasonography of the right upper quadrant and appendix, obstetric, testicular, soft tissue/musculoskeletal, and ocular ultrasonography. Ultrasonography has become an integral part of EM over the past two decades, and it is an important skill which positively influences patient outcomes.
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Affiliation(s)
- Micah R Whitson
- Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA.
| | - Paul H Mayo
- Hofstra Northwell School of Medicine, Long Island Jewish Medical Center, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA
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Abstract
Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients. For the assessment of systemic hypoperfusion and renal dysfunction, point-of-care renal Doppler US may be an option. Utilization of point-of-care US is also considered in order to detect abdominal and pelvic lesions. It is particularly useful for the detection of gallstones and the diagnosis of acute cholecystitis. Point-of-case US is justified as the initial imaging modality for the diagnosis of ureterolithiasis and the assessment of pyelonephritis. It can be used with great accuracy to detect the presence of abdominal aortic aneurysm in symptomatic patients. It may also be useful for the diagnoses of digestive tract diseases such as appendicitis, small bowel obstruction, and gastrointestinal perforation. Additionally, point-of-care US can be a modality for assisting procedures. Paracentesis under US guidance has been shown to improve patient care. US appears to be a potential modality to verify the placement of the gastric tube. The estimation of the amount of urine with bladder US can lead to an increased success rate in small children. US-guided catheterization with transrectal pressure appears to be useful in some male patients in whom standard urethral catheterization is difficult. Although a greater accumulation of evidences is needed in some fields, point-of-care abdominal US is a promising modality to improve patient care in emergency and critical care settings.
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Affiliation(s)
- Toru Kameda
- Department of Emergency Medicine, Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino, Nagano 399-8292 Japan
| | - Nobuyuki Taniguchi
- Department of Clinical Laboratory Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498 Japan
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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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Tabbut M, Harper D, Gramer D, Jones R. High-frequency linear transducer improves detection of an intrauterine pregnancy in first-trimester ultrasonography. Am J Emerg Med 2016; 34:288-91. [DOI: 10.1016/j.ajem.2015.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/01/2015] [Indexed: 11/18/2022] Open
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Chiem AT, Soucy Z, Dinh VA, Chilstrom M, Gharahbaghian L, Shah V, Medak A, Nagdev A, Jang T, Stark E, Hussain A, Lobo V, Pera A, Fox JC. Integration of Ultrasound in Undergraduate Medical Education at the California Medical Schools: A Discussion of Common Challenges and Strategies From the UMeCali Experience. J Ultrasound Med 2016; 35:221-233. [PMID: 26764278 DOI: 10.7863/ultra.15.05006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/26/2015] [Indexed: 06/05/2023]
Abstract
Since the first medical student ultrasound electives became available more than a decade ago, ultrasound in undergraduate medical education has gained increasing popularity. More than a dozen medical schools have fully integrated ultrasound education in their curricula, with several dozen more institutions planning to follow suit. Starting in June 2012, a working group of emergency ultrasound faculty at the California medical schools began to meet to discuss barriers as well as innovative approaches to implementing ultrasound education in undergraduate medical education. It became clear that an ongoing collaborative could be formed to discuss barriers, exchange ideas, and lend support for this initiative. The group, termed Ultrasound in Medical Education, California (UMeCali), was formed with 2 main goals: to exchange ideas and resources in facilitating ultrasound education and to develop a white paper to discuss our experiences. Five common themes integral to successful ultrasound education in undergraduate medical education are discussed in this article: (1) initiating an ultrasound education program; (2) the role of medical student involvement; (3) integration of ultrasound in the preclinical years; (4) developing longitudinal ultrasound education; and (5) addressing competency.
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Affiliation(s)
- Alan T Chiem
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.).
| | - Zachary Soucy
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Vi Am Dinh
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Mikaela Chilstrom
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Laleh Gharahbaghian
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Virag Shah
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Anthony Medak
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Arun Nagdev
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Timothy Jang
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Elena Stark
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Aliasgher Hussain
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Viveta Lobo
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - Abraham Pera
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
| | - J Christian Fox
- Olive View-UCLA Medical Center, UCLA Geffen School of Medicine, Sylmar, California USA (A.T.C.); Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire USA (Z.S.); Loma Linda University School of Medicine, Loma Linda, California USA (V.A.D.); University of Southern California Keck School of Medicine, Los Angeles, California USA (M.C.); Stanford University School of Medicine, Stanford, California USA (L.G., V.L.); University of California San Diego School of Medicine, San Diego, California USA (V.S., A.M.); Highland General Hospital, University of California San Francisco School of Medicine, Oakland, California USA (A.N.); Harbor-UCLA Medical Center, UCLA Geffen School of Medicine, Los Angeles, California USA (T.J., A.H.); UCLA Geffen School of Medicine, Los Angeles, California USA (E.S.); Touro University College of Medicine, San Francisco, California USA (A.P.); and University of California Irvine School of Medicine, Irvine, California USA (J.C.F.)
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43
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Abstract
Diagnosis and treatment of acute pelvic pain in the adolescent female requires differentiating among a broad differential diagnosis that includes potentially serious illness across several organ systems. The case presented provides an illustration of the assessment and management of acute pelvic pain, and key teaching points about important potential causes.
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Affiliation(s)
- M Samuels-Kalow
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia PA and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
| | - C Mollen
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia PA and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania
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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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Flores AH, Kassamali S, Won GY, Stein JC, Reynolds T. Frequency of utilisation of ultrasound in the diagnosis of ectopic pregnancy in Sub-Saharan Africa countries: A systematic review. Afr J Emerg Med 2015. [DOI: 10.1016/j.afjem.2014.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Polena V, Huchon C, Varas Ramos C, Rouzier R, Dumont A, Fauconnier A. Non-invasive tools for the diagnosis of potentially life-threatening gynaecological emergencies: a systematic review. PLoS One 2015; 10:e0114189. [PMID: 25723401 PMCID: PMC4344336 DOI: 10.1371/journal.pone.0114189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/05/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To identify non-invasive tools for diagnosis of the major potentially life-threatening gynaecological emergencies (G-PLEs) reported in previous studies, and to assess their diagnostic accuracy. METHODS MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library) were searched to identify all eligible studies published in English or French between January 1990 and December 2012. Studies were considered eligible if they were primary diagnostic studies of any designs, with a gold standard and with sufficient information for construction of a 2 × 2 contingency table, concerning at least one of the following G-PLEs: complicated ectopic pregnancy, complicated pelvic inflammatory disease, adnexal torsion and haemoperitoneum of any gynaecological origin. Extraction of data and assessment of study quality were conducted by two independent reviewers. We set the thresholds for the diagnostic value of signs retrieved at Sensibility ≥ 95% and LR-≤ 0.25, or Specificity ≥ 90% and LR+ ≥ 4. RESULTS We identified 8288 reports of diagnostic studies for the selected G-PLEs, 45 of which met the inclusion criteria. The methodological quality of the included studies was generally low. The most common diagnostic tools evaluated were transvaginal ultrasound (20/45), followed by medical history (18/45), clinical examination (15/45) and laboratory tests (14/45). Standardised questioning about symptoms, systolic blood pressure<110 mmHg, shock index>0.85, identification of a mass by abdominal palpation or vaginal examination, haemoglobin concentration <10 g/dl and six ultrasound and Doppler signs presented high performances for the diagnosis of G-PLEs. Transvaginal ultrasound was the diagnostic tool with the best individual performance for the diagnosis of all G-PLEs. CONCLUSION This systematic review suggests that blood pressure measurement, haemoglobin tests and transvaginal ultrasound are cornerstone examinations for the diagnosis of G-PLEs that should be available in all gynaecological emergency care services. Standardised questioning about symptoms could be used for triage of patients.
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Affiliation(s)
- Viola Polena
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Cyrille Huchon
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
| | - Catalina Varas Ramos
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France
| | - Roman Rouzier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Surgery, Institut Curie, 35 rue Dailly, 92210, Saint-Cloud, France
| | - Alexandre Dumont
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Institut de Recherche pour le Développement, UMR 216, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Arnaud Fauconnier
- EA 7285 Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), 78180, Montigny-le-Bretonneux, France; Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78103, Poissy, France
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Barker LT, Zhou S. The Diagnosis of Ectopic Pregnancy. Ann Emerg Med 2015; 66:192-3. [PMID: 25544735 DOI: 10.1016/j.annemergmed.2014.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Indexed: 11/24/2022]
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48
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Abstract
: Ectopic pregnancy (EP) is a leading cause of maternal morbidity and mortality. Rates of EP have declined, yet ethnic, socioeconomic, and age-related disparities persist. Improved ultrasound resolution, the use of emergency transvaginal ultrasounds, and improved lab sensitivity have enabled earlier diagnosis, which could further improve outcomes for patients with EP.
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Affiliation(s)
- Noah Gatzke
- Noah Gatzke is an emergency Nurse Practitioner at Health Sciences Centre, Adult ER, Winnipeg, MB. Laura Johnson is an instructor at the University of Manitoba, Faculty of Nursing, and a Nurse Practitioner Health Sciences Center Adult Emergency, Winnipeg, MB
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French S, Henry T, Williams EW. Evaluation of waiting times and sonographic findings in patients with first trimester vaginal bleeding at the university hospital of the west indies. Can emergency department ultrasound make a difference? W INDIAN MED J 2014; 63:247-51. [PMID: 25314282 DOI: 10.7727/wimj.2013.230] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pregnant female patients with vaginal bleeding in the first trimester are seen commonly in the Emergency Department (ED) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. The protocol for the management of these patients requires that they have a sonographic evaluation performed for the purpose of localizing the pregnancy where possible, to assist with determining the risk for an ectopic pregnancy. The ultrasound examinations are performed in the radiology department. OBJECTIVE This retrospective study was conducted to evaluate how long patients wait for a pelvic ultrasound. We also sought to establish how many patients had ultrasound findings that would have allowed safe discharge home. METHODS The records of 150 patients seen in the six-month period from January 1 to July 30, 2008 were examined. Data were extracted pertaining to age, time to see an emergency room doctor, time taken for ultrasound examination to be obtained from the radiology department and the ultrasound findings. RESULT Fifty-four per cent presented to the Emergency Department with a complaint of vaginal bleeding and abdominal pain, 29% with bleeding only, 16% with abdominal pain only and one with syncope. One hundred and sixteen of the patients enrolled had an ultrasound performed at UHWI. The average waiting time for an ultrasound was 3.8 ± 2.5 hours. The majority (66/116) of the patients had an intrauterine pregnancy (IUP) demonstrated on ultrasound. Twenty-nine had no IUP, free fluid or adnexal mass. These 95 patients would likely have been discharged home. Ten patients had an adnexal mass with or without free fluid, and ten had free fluid only on ultrasound. One patient was found to have a definite ectopic pregnancy. These 21 patients would have been referred for evaluation by the obstetrician on call for further management. CONCLUSION The majority of patients had sonographic findings that would have allowed safe and timely discharge from the Emergency Department had ultrasound been available at the point of care.
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50
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Papillon-smith J, Imam B, Patenaude V, Abenhaim HA. Population-Based Study on the Effect of Socioeconomic Factors and Race on Management and Outcomes of 35,535 Inpatient Ectopic Pregnancies. J Minim Invasive Gynecol 2014; 21:914-20. [DOI: 10.1016/j.jmig.2014.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 11/24/2022]
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