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Peach M, Milne J, Diegelmann L, Lamprecht H, Stander M, Lussier D, Pham C, Henneberry R, Fraser J, Chandra K, Howlett M, Mekwan J, Ramrattan B, Middleton J, van Hoving N, Taylor L, Dahn T, Hurley S, MacSween K, Richardson L, Stoica G, Hunter S, Olszynski P, Chandra K, Lewis D, Atkinson P. Does point-of-care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? An international randomized controlled trial from the SHOC-ED investigators. CAN J EMERG MED 2023; 25:48-56. [PMID: 36577931 DOI: 10.1007/s43678-022-00431-9] [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: 02/08/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE Point-of-care ultrasonography (POCUS) is an established tool in the management of hypotensive patients in the emergency department (ED). We compared the diagnostic accuracy of a POCUS protocol versus standard assessment without POCUS in patients with undifferentiated hypotension. METHODS This was an international, multicenter randomized controlled trial included three EDs in North America and three in South Africa from September 2012 to December 2016. Hypotensive patients were randomized to early POCUS protocol plus standard care (POCUS group) or standard care without POCUS (control group). Initial and secondary diagnoses were recorded at 0 and 60 min. The main outcome was measures of diagnostic accuracy of a POCUS protocol in differentiating between cardiogenic and non-cardiogenic shock. Secondary outcomes were diagnostic performance for shock sub-types, as well as changes in perceived category of shock and overall diagnosis. RESULTS Follow-up was completed for 270 of 273 patients. For cardiogenic shock, the POCUS-based diagnostic approach (POCUS) performed similarly to the non-POCUS approach (control) for specificity [95.5% (89.9-98.5) vs.93.8% (87.7-97.5)]; positive likelihood ratio (17.92 vs 14.80); negative likelihood ratio (0.21 vs 0.09) and diagnostic odds ratio (85.6 vs 166.57), with a similar overall diagnostic accuracy between the two approaches [93.7% (88-97.2) vs 93.6% (87.8-97.2)]. Diagnostic performance measures were similar across sub-categories of shock. CONCLUSION This is the first randomized controlled trial to compare diagnostic performance of a POCUS protocol to standard care without POCUS in undifferentiated hypotensive ED patients. POCUS performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test; however, performance did not differ meaningfully from standard assessment.
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Affiliation(s)
- M Peach
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - J Milne
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Fraser Health Authority, Vancouver, BC, Canada
| | - L Diegelmann
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, USA
| | - H Lamprecht
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - M Stander
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - D Lussier
- Department of Emergency Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - C Pham
- Department of Emergency Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - R Henneberry
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - J Fraser
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
| | - K Chandra
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - M Howlett
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - J Mekwan
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - B Ramrattan
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - J Middleton
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - N van Hoving
- Division of Emergency Medicine, University of Stellenbosch, Cape Town, South Africa
| | - L Taylor
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
| | - T Dahn
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - S Hurley
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - K MacSween
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - L Richardson
- Department of Emergency Medicine, Dalhousie University, QEII, Halifax, NS, Canada
| | - G Stoica
- Research Services, Horizon Health Network, Saint John, NB, Canada
| | - Samuel Hunter
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - P Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada
| | - K Chandra
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - D Lewis
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada
| | - P Atkinson
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John Regional Hospital, 400 University Ave, Saint John, NB, NB E2L 4L2, Canada.
- Dalhousie Medicine New Brunswick, Saint John, NB, Canada.
- Discipline of Emergency Medicine, Memorial University, Saint John, NL, Canada.
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Ekambaram K, Lamprecht H, Lalloo V, Caruso N, Engelbrecht A, Jooste W. An electronic survey of preferred podcast format and content requirements among trainee emergency medicine specialists in four Southern African universities. Afr J Emerg Med 2021; 11:3-9. [PMID: 33318911 PMCID: PMC7724151 DOI: 10.1016/j.afjem.2020.10.014] [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: 09/22/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Global usage of educational Emergency Medicine (EM) podcasts is popular and ever-increasing. This study aims to explore the desired content, format and delivery characteristics of a potential educational, context-specific Southern African EM podcast, by investigating current podcast usages, trends and preferences among Southern African EM registrars of varying seniority. METHODS We developed an electronic survey - using a combination of existing literature, context-specific specialist-training guidance, and input from local experts - exploring preferred podcast characteristics among EM registrars from four Southern African universities. RESULTS The study's response rate was 75%, with 24 of the 39 respondents being junior registrars. Ninety-four percent (94%) of respondents used EM podcasts as an educational medium: 64% predominantly using podcasts to supplement a personal EM study program. The primary mode of accessing podcasts was via personal mobile devices (84%). Additionally, respondents preferred a shorter podcast duration (5-15 min), favoured multimedia podcasts (56%) and showed an apparent aversion toward recorded faculty lectures (5%). Eighty-two percent (82%) of respondents preferred context-specific podcast content, with popular topics including toxicology (95%), cardiovascular emergencies (79%) and medico-legal matters (74%). Just-in-Time learning proved an unpopular learning strategy in our study population, despite its substantial educational value. CONCLUSION Podcast-usage proved to be near-ubiquitous among the studied Southern African EM registrars. Quintessentially, future context-specific podcast design should cater for mobile device-use, shorter duration podcasts, more video content, context-specific topics, and content optimised for both Just-in-Time learning.
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Affiliation(s)
- K. Ekambaram
- Division of Emergency Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H. Lamprecht
- Division of Emergency Medicine, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - V. Lalloo
- Division of Emergency Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - N. Caruso
- Division of Emergency Medicine, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - A. Engelbrecht
- Division of Emergency Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - W. Jooste
- New Somerset Hospital, Cape Town, South Africa
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