Abstract
To determine the test performance characteristics for point-of-care ultrasound performed by clinicians compared with computed tomography (CT) diagnosis of skull fractures. METHODS: We conducted a prospective study in a convenience sample of patients #21 years of age who presented to the emergency de- partment with head injuries or suspected skull fractures that re- quired CT scan evaluation. After a 1-hour, focused ultrasound training session, clinicians performed ultrasound examinations to evaluate patients for skull fractures. CT scan interpretations by at- tending radiologists were the reference standard for this study. Point- of-care ultrasound scans were reviewed by an experienced sonologist to evaluate interobserver agreement. RESULTS: Point-of-care ultrasound was performed by 17 clinicians in 69 subjects with suspected skull fractures. The patients' mean age was 6.4 years (SD: 6.2 years), and 65% of patients were male. The prevalence of fracture was 12% (n = 8). Point-of-care ultrasound for skull fracture had a sensitivity of 88% (95% confidence interval (CI): 53%-98%), a specificity of 97% (95% CI: 89%-99%), a positive likelihood ratio of 27 (95% CI: 7-107), and a negative likelihood ratio of 0.13 (95% CI: 0.02-0.81). The only false-negative ultrasound scan was due to a skull fracture not directly under a scalp hematoma, but rather adjacent to it. The k for interobserver agreement was 0.86 (95% CI: 0.67-1.0). CONCLUSIONS: Clinicians with focused ultrasound training were able to diagnose skull fractures in children with high specificity. Pediatrics 2013;131:e1757-e1764
Highlights
The test characteristics of thoracic Point of Care Ultrasonography (PoCUS) for the diagnosis of acute congestive heart failure (CHF) are not well known, and no prior study evaluated the diagnostic impact of pleural effusions
That might be atribbuted to variable interpretation of ultrasound anatomy – what are we really measuring? Objective: We performed a proof of concept study to evaluate the accuracy of measurments of the optic nerve sheath diameter (ONSD) for contrast enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI)
Good correlation of measurment values was found between CEUS and MRI (ICC 0.98, 95% collapsibility index (CI), 0.74 – 0.99), MRI being regarded as a gold standard
Summary
Measurement of the Inferior Vena Cava (IVC) diameters and collapsibility index (CI) for the detection of early volume depletion in healthy donors was recently investigated by Resnick et al who showed no significant changes using different approaches after blood loss. Objective: To investigate the usefulness of IVC diameters and CI measurement to detect early volume depletion after blood loss of 400450 ml using different sonographic windows. The mid hepatic long-axis window showed the best correlation between the IVC-CI and early volume variations following blood loss and post-donation volume repletion. The 8% remaining was in different areas of the upper limb Cite abstracts in this supplement using the relevant abstract number, e.g.: Ruiz Chacon et al.: Ecography guided puncture vs traditional puncture lancing: benefits for patients at risk in number of attempts to giving comfortable area.
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