Impact Of Point-of-care Ultrasound Research Articles

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine.

There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine - this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care. POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced - its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care. POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.

Use of Point-of-Care Ultrasound by Intensive Care Unit Triage Teams in Evaluating Unstable Patients Outside Intensive Care Units.

Introduction Point-of-care ultrasound (POCUS) has become an integral asset in intensive care units (ICUs). However, there is limited literature on the value of POCUS in evaluating deteriorating patients outside the ICU. In this study, we sought to investigate the use and impact of POCUS by ICU triage teams in hospitals outside of the ICU setting. Methods ICU triage fellows were provided a portable ultrasound to use as part of their evaluations during consultations and hospital code activations. Fellows were asked to fill out a survey on how ultrasound was used and its impact on patient management. Free-text data such as reason for ultrasound use, views obtained, clinical impressions before and after ultrasound, and clinical actions were recorded. These data were transcribed and categorized electronically. Results A total of 51 total resuscitations were documented. The most common reason for ICU triage team evaluation was hypotension (53%, N=27). The most common clinical focus for ultrasound use was cardiac assessment (53%, N=27), followed by volume status assessment (35%, N=18). The most common ultrasound views per encounter obtained were parasternal long (82%, N=42), followed by apical four-chamber view (76%, N=39) and subcostal view (75%, N=38). Out of 38 encounters with clinical impressions documented, 79% (N=30) of pre-ultrasound clinical impressions were confirmed by ultrasound use. Of total encounters, 35% (N=18) had a significant clinical action taken based on ultrasound findings (fluid resuscitation, vasopressor initiation, etc.). Conclusions Ultrasound is a valuable tool for patient evaluation in non-ICU wards, especially in confirming clinical impressions and guiding therapeutic actions. Some limitations of this study include reporting bias and incomplete capture of ultrasound use in non-ICU wards.

Factors affecting point-of-care ultrasound implementation in general practice: a survey in Danish primary care clinics

ObjectiveThe implementation of point-of-care ultrasound (POCUS) in general practice varies, but it is unknown what determines this variation. The purpose of this study was to explore (1) the overall proportion...

1152: USE OF POINT-OF-CARE ULTRASOUND IN EVALUATING UNSTABLE PATIENTS OUTSIDE INTENSIVE CARE UNITS

Introduction: Point of care ultrasound (POCUS) has become an integral asset in intensive care units (ICU). However, there is limited literature on the value of POCUS in evaluating deteriorating patients outside ICU. In this study, we sought to investigate the use and impact of POCUS by ICU triage teams in hospitals outside of the ICU. Methods: For consults and rapid responses, ICU fellows were provided a portable ultrasound to use as part of their patient evaluations. Fellows were asked to fill out a survey regarding how ultrasound was used and its impact on patient management. Free text data such as reason for ultrasound use, views obtained, clinical impressions before and after ultrasound as well as how clinical decisions changed were recorded. These data were transcribed and categorized electronically, and then analyzed via Stata. Results: 51 total resuscitations were documented. The most common reason for ICU triage team evaluation was hypotension (53%). The most common clinical focus for ultrasound usage was volume status assessment (35%), followed by cardiac assessment (31%) and then pulmonary embolism evaluation (14%). Most common ultrasound views obtained were parasternal long (82%), followed by apical 4 chamber (76%) and subcostal views (75%). 79% of pre-ultrasound clinical impressions were confirmed by ultrasound use. However, when assessing for pulmonary embolisms, 40% of clinical impressions changed after using ultrasound. 37% of encounters had a significant clinical action taken based on ultrasound findings (fluid resuscitation, vasopressor initiation, etc), which increased to 50% when specifically evaluating cardiac assessment and volume status. Conclusions: Ultrasound is a valuable tool in patient evaluation on non-ICU wards especially in confirming clinical impressions and guiding therapeutic actions. Some limitations of this study include reporting bias and incomplete capture of all ultrasound usage on non-ICU wards. Next steps will include further analysis on specific presenting complaints (i.e mental status change, hypotension, dyspnea) and outcomes based on ultrasound usage outside the ICU.

Resident perception on the impact of point-of-care ultrasound in clinical care at a family medicine training program in Zambia

BackgroundPatient access to necessary medical imaging in low- and middle-income countries (LMICs) remains a major obstacle, complicating clinician decision-making and compromising patient outcomes.MethodsWe implemented a longitudinal point-of-care ultrasound (POCUS) training program at a new Family Medicine residency in Zambia and subsequently evaluated residents’ perceptions on the impact of POCUS in patient care. Data were documented by the scanning resident via a post-scan survey, which assessed if/how the scan assisted in medical management, and if/how the scan changed that management. The primary endpoint was frequency of scans assisting and changing management. Data were summarized using descriptive statistics.ResultsOver the 1-year study period, 366 patient encounters occurred in which POCUS was utilized, resulting in a total of 542 unique POCUS scans. POCUS assisted in decision-making in 95.6% (350/366) of patient encounters, most commonly by helping to determine a diagnosis. POCUS changed management in 65.8% (235/357) of patient encounters, most commonly leading to a medication change.ConclusionsZambian resident physicians perceived POCUS to be very helpful in their clinical decision-making. These data support the need to advance POCUS education at the residency level throughout LMICs, which may be an ideal strategy to promote widespread utilization of POCUS in low-resource settings globally.

Diagnostic point-of-care ultrasound in medical inpatients at Queen Elizabeth Central Hospital, Malawi: an observational study of practice and evaluation of implementation.

BackgroundIn less well-resourced settings, where access to radiology services is limited, point-of-care ultrasound (POCUS) can be used to assess patients and guide clinical management. The aim of this study was to describe ultrasound practice in the assessment of medical inpatients at Queen Elizabeth Central Hospital, Blantyre, Malawi, and evaluate uptake and impact of POCUS following the introduction of a training programme at the college of Medicine, Blantyre, Malawi.Methods: A weekly prospective record review of sequential adult medical inpatients who had received an ultrasound examination was conducted.ResultsOf 835 patients screened, 250 patients were included; 267 ultrasound examinations were performed, of which 133 (50%) were POCUS (defined as performed by a clinician at the bedside). The time from request to performance of examination was shorter for POCUS examinations than radiology department ultrasound (RDUS) (median 0 [IQR 0–2, range 0–11] vs 2 [IQR 1–4, range 0–15] d, p=0.002); 104/133 (78.2%) POCUS and 90/133 (67.7%) RDUS examinations were deemed to have an impact on management.ConclusionFollowing the introduction of a training programme in POCUS, half of all ultrasound examinations were delivered as POCUS. POCUS was performed rapidly and impacted on patient management. POCUS may relieve the burden on radiology services in less well-resourced settings.

Evidence-Based Medicine Improves the Emergent Management of Peritonsillar Abscesses Using Point-of-Care Ultrasound.

Physical examination for peritonsillar abscess (PTA) has limited sensitivity. Traditional management involves blind needle aspiration, which has a false negative rate of 10-24%. A randomized controlled trial by Costantino etal. demonstrated that point-of-care ultrasound (POCUS) improves PTA management. Compare the use and impact of POCUS between patient cohorts prior to and after the trial by Costantino etal. Retrospective cohort study of adult patients diagnosed with PTA. Cohort 1 presented to the emergency department (ED) January 2007-December 2008. Cohort 2 presented between January 2013 and December 2014. Data were separated into those with POCUS vs. without ultrasound (NUS). Primary endpoint was POCUS utilization. Secondary endpoints were successful aspiration, otolaryngology (ear, nose, and throat [ENT]) consultation, computed tomography (CT) imaging, unscheduled return visits, and length of stay (LOS). The Fisher's exact and t-tests analyzed data. Cohort 1 enrolled 48 patients, vs. 114 patients for cohort 2. Twelve patients in cohort 1 had a POCUS (25%) vs 89 in cohort 2 (78%) (p<0.0001; odds ratio [OR] 0.09 (95% confidence interval [CI] 0.04-0.20). Emergency physician (EP) successful aspiration: 89.1% POCUS vs. 24.5% NUS (p<0.0001; OR 25 [95% CI 10-59]). Combined EP/ENT successful aspiration: 99.0% POCUS vs. 80.3% NUS (p<0.0001; OR 24 [95% CI 3-193]). ENT consultation:12.9% POCUS vs. 65.6% NUS (p<0.0001; OR 0.07 [95% CI 0.03-0.17]). CT usage: 23.8% POCUS vs. 37.7% NUS (p=0.07; OR 0.51 [95% CI 0.25-1.02]). Return visits: 3.96% POCUS vs. 18.0% NUS (p=0.004; OR 0.18 [95% CI 0.05-0.61]). POCUS use has increased for PTA treatment, improves aspiration, and decreases consultations, CTs, return visits, and LOS.

Impact of point-of-care ultrasound on clinical decision-making at an urban emergency department in Tanzania.

BackgroundPoint of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be particularly useful in resource-limited settings. However, its impact on clinical decision making in such settings has not been well studied. The objective of this study is to describe the utilization and impact of PoCUS on clinical decision making at an urban emergency department in Dar es Salaam, Tanzania.MethodsThis was a prospective descriptive cross-sectional study of patients receiving PoCUS at Muhimbili National Hospital’s Emergency Medical Department (MNH EMD). Data on PoCUS studies during a period of 10 months at MNH EMD was collected on consecutive patients during periods when research assistants were available. Data collected included patient age and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic impression and disposition plan before and after PoCUS. Descriptive statistics, including medians and interquartile ranges, and counts and percentages, are reported. Pearson chi squared tests and p-values were used to evaluate categorical data for significant differences.ResultsPoCUS data was collected for 986 studies performed on 784 patients. Median patient age was 32 years; 56% of patients were male. Top indications for PoCUS included trauma, respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians reported that the use of PoCUS changed either diagnostic impression or disposition plan in 29% of all cases. Rates of change in diagnostic impression or disposition plan increased to 45% in patients for whom more than one PoCUS study type was performed.ConclusionsIn resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications and has substantial impact on clinical decision making, especially when more than one study type is performed.

Point-of-care gastric ultrasound and aspiration risk assessment: a narrative review.

This narrative review summarizes the current knowledge on point-of-care ultrasound (POCUS) of gastric contents in order to inform an assessment of aspiration risk and guide anesthetic management at the bedside. An I-AIM framework (Indication, Acquisition, Interpretation, and Medical decision-making) is used to summarize and organize the content areas. This narrative review spans the breadth of the literature on pediatric and adult subjects as well as on special patient populations such as obstetric and severely obese individuals. Areas that need further investigation include the diagnostic accuracy of gastric POCUS from a Bayesian perspective and the impact of POCUS on patient outcomes, healthcare economics, and educational curricula.

Point-of-care ultrasound use over six-month training period in Rwandan district hospitals

Introduction Point-of-care ultrasound (POCUS) is an effective diagnostic technology in resource-limited settings. There is increasing interest in introducing ultrasound training in such environments, but few reports describing long-term follow-up and impact of a POCUS program in a resource-limited setting. We introduced a POCUS program in Rwanda, and sought to determine the number and type of ultrasounds performed, the impact of a remote quality assurance (QA) program, and the effect of POCUS on patient management. Methods Seventeen Rwandan physicians underwent a ten-day training course in POCUS in Kigali, Rwanda. Post-course, participants tracked the ultrasounds they performed using a cloud-based storage system, recorded clinical impressions, and received periodic QA with on-site proctoring over a six-month follow-up. Remote QA to evaluate image quality was performed by five emergency ultrasound fellowship-trained clinicians. Images were graded on a scale of 0–4. (0=no meaningful image, 2=adequate, 4=outstanding). Trainees also documented how POCUS changed clinical management. Results Over six months, 1158 ultrasounds were performed and logged by fifteen participants at eleven regional hospitals. 590 (50.9%) had matched images and interpretations available for review. Abdominal ultrasound was the most frequently performed application (19.7%), followed by liver (14.6%), obstetrics (14.5%), renal (12.4%), and spleen (11%). Across all applications, the mean score was 2.5 (SD±0.11, 95% confidence interval, 2.39–2.54). Ultrasound resulted in a management change in 84% of cases. Major changes in management related to medication choice (42.4%), admission (30%), transfer to a higher level of care (28.1%), and performance of procedures (23.3%). Conclusions During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51% of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting.