Emergency Medicine Ultrasound Research Articles

Pediatric Emergency Medicine Ultrasound Fellowship Programs.

Point of care ultrasound (POCUS) has undergone important growth in the field of Pediatric Emergency Medicine (PEM) in the last 14 years and is recognized as a critical diagnostic tool in the care of ill and injured children. The first PEM POCUS fellowship was established in 2010. Now, there are currently 30 ultrasound fellowships that offer training to PEM physicians. In 2014, 46 PEM POCUS leaders established the P2 (PEM POCUS) Network (www.P2network.org). This serves as a platform for sharing expertise, building research collaborations, and offering mentorship in the use of POCUS in PEM. In 2019, a multinational group of experts in PEM POCUS published the first consensus guidelines for prioritizing core applications of POCUS, which are fundamental to PEM fellowship training 1. In 2022, the international research priorities for PEM POCUS were published 2. In the same year, the development of a consensus-based definition of focused assessment with sonography for trauma (FAST) in children was established 3.

Point-of-Care Ultrasound-History, Current and Evolving Clinical Concepts in Emergency Medicine.

Point-of-care ultrasound (PoCUS) has become an indispensable standard in emergency medicine. Emergency medicine ultrasound (EMUS) is the application of bedside PoCUS by the attending emergency physician to assist in the diagnosis and management of many time-sensitive health emergencies. In many ways, using PoCUS is not only the mere application of technology, but also a fusion of already existing examiner skills and technology in the context of a patient encounter. EMUS practice can be defined using distinct anatomy-based applications. The type of applications and their complexity usually depend on local needs and resources, and practice patterns can vary significantly among regions, countries, or even continents. A different approach suggests defining EMUS in categories such as resuscitative, diagnostic, procedural guidance, symptom- or sign-based, and therapeutic. Because EMUS is practiced in a constantly evolving emergency medical setting where no two patient encounters are identical, the concept of EMUS should also be practiced in a fluid, constantly adapting manner driven by the physician treating the patient. Many recent advances in ultrasound technology have received little or no attention from the EMUS community, and several important technical advances and research findings have not been translated into routine clinical practice. The authors believe that four main areas have great potential for the future growth and development of EMUS and are worth integrating: 1. In recent years, many articles have been published on novel ultrasound applications. Only a small percentage has found its way into routine use. We will discuss two important examples: trauma ultrasound that goes beyond e-FAST and EMUS lung ultrasound for suspected pulmonary embolism. 2. The more ultrasound equipment becomes financially affordable; the more ultrasound should be incorporated into the physical examination. This merging and possibly even replacement of aspects of the classical physical exam by technology will likely outperform the isolated use of stethoscope, percussion, and auscultation. 3. The knowledge of pathophysiological processes in acute illness and ultrasound findings should be merged in clinical practice. The translation of this knowledge into practical concepts will allow us to better manage many presentations, such as hypotension or the dyspnea of unclear etiology. 4. Technical innovations such as elastography; CEUS; highly sensitive color Doppler such as M-flow, vector flow, or other novel technology; artificial intelligence; cloud-based POCUS functions; and augmented reality devices such as smart glasses should become standard in emergencies over time.

Pediatric Emergency Medicine Ultrasound Fellowship Programs.

Director, Pediatric Emergency Ultrasound, Massachusetts General Hospital, Harvard Medical School Director, Pediatric Emergency Ultrasound, Children’s Healthcare of Atlanta, Emory University School of Medicine

Pediatric Emergency Medicine Ultrasound Fellowship Programs.

Pediatric Emergency Medicine Ultrasound Fellowship Programs.

Pediatric Emergency Medicine Ultrasound Fellowship Programs.

Director, Pediatric Emergency Ultrasound Massachusetts General Hospital Harvard Medical School Director, Pediatric Emergency Ultrasound Children’s Healthcare of Atlanta Emory University School of Medicine

An analysis of Twitter for an Academic Emergency Medicine Ultrasound Division.

An analysis of Twitter for an Academic Emergency Medicine Ultrasound Division.

Clinical Integration of Point-of-care Ultrasound by Emergency Medicine Residents: A Single-center Mixed-methods Study.

Point-of-care ultrasound (POCUS) competence consists of image acquisition, image interpretation, and clinical integration. Limited data exist on POCUS usage patterns and clinical integration by emergency medicine (EM) residents. We sought to determine actual POCUS usage and clinical integration patterns by EM residents and to explore residents' perspectives on POCUS clinical integration. We conducted an explanatory sequential mixed-methods study at a 4-year EM residency program. In phase 1, EM ultrasound (US) attendings observed PGY-4 EM residents' clinical integration of POCUS in real time while on shift in the emergency department (ED). EM US attendings evaluated residents on their intent to perform POCUS, actual POCUS usage, and competence per patient encounter. We used logistic regression to analyze these parameters. In phase 2, we conducted semi-structured interviews with the observed PGY-4 residents regarding POCUS usage and clinical integration in the ED. We analyzed qualitative data for themes. Emergency medicine US attendings observed 10 PGY-4 EM residents during 254 high-acuity patient encounters from December 2018 to March 2019. EM US attendings considered POCUS indicated for 26% (66/254) of patients, possibly indicated for 12% (30/254) and not indicated for 62% (158/254). Of the 66 patients for whom EM US attendings considered POCUS indicated, PGY-4s intended to perform POCUS for patient management 61% (40/66) of the time. PGY-4s subsequently incorporated POCUS into patient management 73% (48/66) of the time. EM US attendings considered PGY-4s entrustable to perform POCUS independently 81% (206/254) of the time. We did not find a statistically significant association between shift volume, shift type, or POCUS application, and resident intent to perform POCUS nor competence. Interviews identified three factors that influence PGY-4's POCUS clinical integration: motivations to use POCUS, barriers to utilization, and POCUS educational methods. This mixed-methods study identified a significant gap in POCUS utilization and clinical integration by PGY-4 EM residents for clinically indicated cases identified by EM US attendings. Asclinical integration is a cornerstone of POCUS competence, it is important to ensure that EM resident POCUS curricula emphasize training on clinical utilization and indications for POCUS while on shift in the ED.

Emergency Medicine Advanced Ultrasound Service: A new paradigm.

Point-of-care ultrasound (POCUS) is now ubiquitous in emergency medicine. Increased accessibility does not, however, ensure expertise in its use. We present a unique model of an Emergency Medicine Advanced Ultrasound Service (EMAUS). In our model specialist emergency physicians with advanced ultrasound (US) qualifications (emergency sonologists), provide images and reports for the entire department. The service is considered an extension of the traditional radiology model. It is consultative, diagnostic and procedural, and includes full US examinations as well as POCUS examinations. A 4-month prospective descriptive observational study was conducted at a tertiary hospital during which data was recorded about emergency medicine US use and its outcomes. A total of 1336 US scans were recorded. Emergency sonologists conducted the majority of examinations, 69.8%. Half the consultative USs demonstrated positive findings. Follow-up computed tomography (CT) was recommended in 8.8% of consultative US studies and 12.4% of POCUS studies. Concerning incidental findings requiring further investigation (usually CT/magnetic resonance imaging) were infrequent at 1.6%. Globally POCUS has proliferated with varying expertise and data to support its use. The EMAUS provides a trusted and accountable service with the advantages of simultaneously integrating consultative US into the clinical context by an emergency physician. A diverse range of indications, scan types and pathology was recorded over the period demonstrating the utility of combining the roles of senior clinician, sonographer and radiologist and the benefits of advanced training and credentialing.

Core Content for Pediatric Emergency Medicine Ultrasound Fellowship Training: A Modified Delphi Consensus Study.

Pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) fellowships exist to provide learners with expertise in ultrasound (US) education, administration, and research oversight. Currently, there are no standardized goals or objectives for these programs, resulting in considerable variability in PEM POCUS fellowship training. A modified Delphi survey of PEM and general emergency medicine (EM) POCUS experts in Canada and the United States was conducted to obtain consensus regarding the most important curricular components of a PEM POCUS fellowship training program. Participants were solicited from the P2 Network mailing list and from PEM and EM POCUS fellowship directors listed on the Society of Clinical Ultrasound Fellowships and the Canadian Society of POCUS-EM Fellowships websites. Curricular components considered as part of the survey included US skills, educational skills, administrative skills, and research requirements. Consensus was considered to have been reached when ≥80% of respondents agreed to either include or exclude the component in fellowship training. Round 1 of the survey was sent to 311 participants. A total of 118 (37.9%) completed eligibility for the survey, and 92 (78.0%) met eligibility criteria. Of those, 80 (67.8% of eligible participants) completed the first round of the survey. Round 2 of the survey was sent to those who completed part 1, and 64 (80.0%) completed that round. During Round 1, consensus was achieved for 15 of 75 US applications, seven of seven educational skills, nine of 11 administrative skills, and four of six research requirements. In Round 2 of the survey, consensus was reached on two additional US skills, but no additional administrative skills or research requirements. With a consensus-building process, the core content for PEM POCUS fellowship training was defined. This can help POCUS educators formulate standardized curricula to create consistent training in POCUS fellowship graduates.

Documenting the Growth of Ultrasound Research in Emergency Medicine Through a Bibliometric Analysis of Accepted Academic Conference Abstracts

Ultrasound (US) has become an indispensable skill for emergency physicians. Growth in the use of US in emergency medicine (EM) has been characterized by practice guidelines, education requirements, and the number of EM US practitioners. Our purpose was to further document the growth of EM US by profiling the breadth, depth, and quality of US-related research presented at EM's most prominent annual research conference: the Society for Academic Emergency Medicine Annual Meeting. We reviewed published research abstracts from the annual Society for Academic Emergency Medicine conferences from 1999 to 2015. Abstracts related to US were identified and examined for the number of authors and rigor of the research design. Designs were categorized as experimental, quasiexperimental, and nonexperimental. Abstract submissions were analyzed by the average rate of change over time. From 1999 to 2015, we observed a 10.2% increase in the number of accepted abstracts related to US research. This rate compared to a 3.2% average rate of change for all abstracts in general. The number of unique authors engaged in US research increased at a rate of 26.6%. Of the 602 abstracts identified as US related, only 12% could be considered experimental research. We observed larger increases in the number of US-related research relative to the total number of abstracts presented at a national conference. The number of investigators engaging in this research has also steadily increased. The research design of these studies was found to be primarily quasiexperimental. To improve the quality of EM's use of point-of-care US, more rigorous research with experimental designs is needed.

2089258 Retrospective Evaluation of A Longitudinal 3rd Year Medical School Ultrasound Curriculum

Attempts to introduce bedside ultrasound into medical education have increased significantly in recent years. Given the expanding role of ultrasound in medicine, determining an efficient and effective manner to educate learners is vitally important. Ultrasound education can serve to reinforce anatomy and pathophysiology, while embracing the LCME accreditation goals of providing active learning with practical opportunities while developing problem solving skills and clinical reasoning. Finally, recent literature reveals medical students feel exposure to ultrasonography is a valuable part of their education. We created a longitudinal ultrasound curriculum for 3rd year medical students. The main OBJECTIVES: was to assess improvement in ultrasound knowledge by means of a pre- and post-curriculum written test. Secondary goal was student proficiency on an ultrasound skills assessment at completion of the curriculum. A convenience sample of six students was introduced to a novel, longitudinal ultrasound curriculum. The students were given a 20-question knowledge assessment prior to beginning an eight month ultrasound curriculum. Each session reviewed a variety of ultrasound specific applications. Students underwent a final testing session that consisted of the same 20-question knowledge assessment and an ultrasound skills assessment. The skills assessment included demonstration of different ultrasound exams on standardized patients, judged by Emergency Medicine Ultrasound faculty. Students demonstrated a 27% improvement on written knowledge assessment after participating in the longitudinal ultrasound curriculum. Additionally, students demonstrated moderate to excellent ability in obtaining pertinent sonographic images and performing ultrasound guided procedures on skills assessment. Overall, students demonstrated improvement in both ultrasound knowledge and technical skills following implementation of a longitudinal curriculum in the 3rd year of medical school. A longitudinal approach to teaching medical students the principles and techniques of bedside ultrasound may be an effective way to introduce this skill into the already extensive medical school curriculum.

A Cohort Study to Evaluate Emergency Medicine Ultrasound by Non-Sonographers in Clinical Practice

Previous research has evaluated the sensitivity and specificity of emergency medicine ultrasound (EMU); however, the literature on clinical governance issues such as the quality of training, competence of the operator, development of clinical guidelines or standard setting within individual trusts is very limited. Although national guidelines have been issued regarding governance of non-radiology performed ultrasound, it is unclear whether the expectations provided within the guidance are being implemented in clinical practice. The aim of this study was to explore the clinical governance and service provision of emergency medicine practitioners who had attended a two-day formal training course on EMU. The method used was a prospective non-randomized study using an electronic questionnaire to 160 clinicians who had attended a two-day EMU course. The questions investigated the clinicians’ EMU clinical practice in their departments including profession, grade, number of scans, types of examinations, equipment used and clinical governance arrangements such as scope of practice, audit, guidelines, support, archiving of reports and images. Responses were obtained from 59 of 160 (37%) delegates. The mean time they had been involved in emergency medicine was 8.31 years. Most (73%) were performing EMU in their current roles. Nearly all (86%) felt that the two-day course had given them adequate training and over half were performing extra examinations to those taught on the course. Only 23 (39%) respondents had supervision in their workplace after the course. Less than half (46%) were aware of national EMU guidelines, and only 22% of respondents indicated there were local clinical guidelines in place. A significant proportion of departments (37%) do not undertake audit. In conclusion, most of the respondents were not aware of the national guidelines around EMU and there was a lack of evidence that clinical governance issues were being enforced by all trusts. Many departments showed a limited use of clinical guidelines, audit regimes or competency assessment.

Resident Training in Emergency Ultrasound: Consensus Recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference

Over the past 25 years, research performed by emergency physicians (EPs) demonstrates that bedside ultrasound (US) can improve the care of emergency department (ED) patients. At the request of the Council of Emergency Medicine Residency Directors (CORD), leaders in the field of emergency medicine (EM) US met to delineate in consensus fashion the model "US curriculum" for EM residency training programs. The goal of this article is to provide a framework for providing US education to EM residents. These guidelines should serve as a foundation for the growth of resident education in EM US. The intent of these guidelines is to provide minimum education standards for all EM residency programs to refer to when establishing an EUS training program. The document focuses on US curriculum, US education, and competency assessment. The use of US in the management of critically ill patients will improve patient care and thus should be viewed as a required skill set for all future graduating EM residents. The authors consider EUS skills critical to the development of an emergency physician, and a minimum skill set should be mandatory for all graduating EM residents. The US education provided to EM residents should be structured to allow residents to incorporate US into daily clinical practice. Image acquisition and interpretation alone are insufficient. The ability to integrate findings with patient care and apply them in a busy clinical environment should be stressed.

Accuracy of Emergency Medicine Ultrasound in the Evaluation of Abdominal Aortic Aneurysm

Accuracy of Emergency Medicine Ultrasound in the Evaluation of Abdominal Aortic Aneurysm

Use of Emergency Bedside Ultrasound by Emergency Medicine Physician Assistants: A New Training Concept

INTRODUCTION Over the past two decades, the application of ultrasound by physicians in the emergency department has become common practice. The adoption of ultrasound skills by emergency physicians resulted from the unique practice environment of emergency medicine, which requires the ability to make timely diagnoses of life-threatening conditions at all hours of the day.1 Ultrasonography is uniquely suited to emergency medicine application. When performed at the patient’s bedside by the treating physician it can provide real-time diagnostic information in many time-sensitive, life-threatening conditions without the delay associated with waiting for an ultrasound technician, who is often not available in the hospital during off hours. Using ultrasound also eliminates the risk associated with requiring potentially unstable patients to leave the emergency department to have tests performed. This need has been recognized by the American College of Emergency Physicians (ACEP). In 1991, the ACEP Board of Directors approved a position statement that for the first time formally supported the use of ultrasound technology by emergency physicians.2 The Society for Academic Emergency Medicine (SAEM) endorsed the ACEP position and published a model curriculum in 1994.3 In 1997 ACEP created a more comprehensive statement, which was updated in 2001. Along with defining specific types of examinations that are considered to be within the domain of the emergency physician, it stated that: “Training in performing and interpreting ultrasound imaging studies should be included in emergency medicine residency curricula.”4 In 1999, the American Medical Association (AMA) Resolution 802 stated that ultrasound use was within the scope of practice of appropriately trained physicians and that credentialing criteria should be developed by each specialty.5 In 2001, ACEP published Marc L. Daymude, MD, FACEP, is medical director and Leonard Gruppo, PA-C, is program director of the Emergency Medicine Physician Assistant Residency at San Antonio Uniformed Services Health Education Consortium; Sumeru Mehta, MD, is director of the Emergency Medicine Ultrasound Program at San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.

355: Revenue Capture in an Emergency Medicine Ultrasound Program: A Pilot Study

355: Revenue Capture in an Emergency Medicine Ultrasound Program: A Pilot Study

Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm

This study assesses the accuracy of Emergency Medicine (EM) residents in detecting the size and presence of abdominal aortic aneurysms (AAAs) using EM ultrasound (EUS) compared to radiology measurement (RAD) by computed tomography (CT) scan, magnetic resonance imaging (MRI), angiography, or operative findings. There were 238 aortic EUS performed from 1999–2000; 36 were positive for AAA. The EUS finding of “AAA” had a sensitivity of 0.94 (0.86–1.0 95% confidence interval [CI]) and specificity of 1 (0.98–1.0 95% CI). Mean aortic diameter among patients with AAA identified by EUS was 5.43 ± 1.95 cm and by RAD was 5.35 ± 1.83 cm. The mean absolute difference between EUS and RAD diameters was 4.4 mm (95% CI 3.7–5.5 mm). Regression of EUS on RAD diameters is strongly correlated, with R 2 = 0.92. EM residents with appropriate training can accurately determine the presence of AAA as well as the maximal aortic diameter.

Proctored Ultrasound Examinations (PUE) Significantly Improve Success in Emergency Medicine Ultrasound Education

Study Objectives: The authors sought to determine whether proctored ultrasound examinations(PUE) improves the performance of emergency medicine interns participating in a didactic-based ultrasound curriculum.

Short and Long Term Effects of Emergency Medicine Ultrasound on Formal U/S Utilization: A Decade of Experience

Short and Long Term Effects of Emergency Medicine Ultrasound on Formal U/S Utilization: A Decade of Experience

Predictors of Success in Emergency Medicine Ultrasound Education

Abstract Objectives: To compare emergency medicine resident performance on an ultrasound‐oriented, American Board of Emergency Medicine–styled written examination with the following variables in resident education: number of ultrasound scans performed, presence of a formal, structured ultrasound rotation, presence of a mandatory ultrasound rotation, number of hours of didactic ultrasound education, and percentage of ultrasound education taught by emergency physicians. Methods: This was a prospective cohort study involving 14 residency programs. A 60‐question multiple‐choice test was completed by individual residents and returned for scoring. Results: 262 residents completed the study. Average score was 39.1/60 ± 6.5 (65%). Scores improved as residency year increased (year 1: 36.6, year 2: 39.3, year 3: 42.6) (p < 0.005). Scores improved as number of scans performed increased from 34.3 (57%) for those residents who had performed 0–10 scans to 45.4 (76%) for those with >150 scans (p < 0.005). The presence of an ultrasound rotation at an emergency medicine residency program also produced a statistically significant increase in test score (OR 1.82; 95% CI = 1.29 to 2.55). Residents at programs spending the least time (6 to 15 hours) on didactic education throughout the residency predicted examination failure (OR 0.60; 95% CI = 0.39 to 0.93). Increasing the amount of resident ultrasound teaching by emergency physicians improved the score, but this did not reach significance (p = 0.357). Conclusions: Improved resident performance on an ultrasound written examination was associated with increasing resident year, number of scans performed, and the presence of an ultrasound rotation at the residency program. Increasing the number of didactic hours spent on ultrasound each year beyond 15 hours showed no improvement in resident performance.