Point-of-care Ultrasound Research Articles

Artificial intelligence-guided screening of under-recognized cardiomyopathies adapted for point-of-care echocardiography

Abstract Background Point-of-care ultrasonography (POCUS) enables access to cardiac imaging directly at the bedside but is limited by brief acquisition, variation in acquisition quality, and lack of advanced protocols. Purpose To develop and validate deep learning models for detecting underdiagnosed cardiomyopathies on cardiac POCUS, leveraging a novel acquisition quality-adapted modeling strategy. Methods To develop the models, we identified transthoracic echocardiograms (TTEs) of patients across five hospitals in a large U.S. health system with transthyretin amyloid cardiomyopathy (ATTR-CM, confirmed by Tc99m-pyrophosphate imaging), hypertrophic cardiomyopathy (HCM, confirmed by cardiac magnetic resonance), and random controls from the same period enriched for the presence of severe AS. In a sample of 290,245 TTE videos, we used novel augmentation approaches and a customized loss function to weigh image and view quality to train a multi-label, view agnostic video-based convolutional neural network (CNN) to discriminate the presence of ATTR-CM, HCM, and/or AS+ and AS- controls. Models were tested across 3,758 real-world POCUS videos from 1,879 studies in 1,330 independent emergency department (ED) patients from 2011 through 2023 (A). Results Our multi-label, view-agnostic classifier demonstrated state-of-the-art performance in discriminating ATTR-CM (AUROC 0.98 [95%CI: 0.96-0.99]) and HCM (AUROC 0.95 [95% CI: 0.94-0.96]) on standard TTE studies. Automated metrics of anatomical view correctness confirmed significantly lower quality in POCUS vs TTE videos (median view classifier confidence of 0.63 [IQR: 0.44-0.88] vs 0.93 [IQR: 0.69-1.00], p<0.001). When deployed to POCUS videos, our algorithm effectively discriminated ATTR-CM and HCM with AUROC of up to 0.94 (parasternal long-axis (PLAX)), and 0.85 (apical 4 chamber (A4C)) (B), corresponding to positive diagnostic odds ratios of 46.7, and 25.5, respectively. In total, 18/35 (51.4%) of ATTR-CM and 32/57 (41.1%) of HCM patients in the POCUS cohort had a positive AI screen in the year before their eventual confirmatory imaging (C). Conclusions We define and validate an AI framework that enables scalable, opportunistic screening of under-diagnosed cardiomyopathies using POCUS.

Deep learning improves detection of aortic stenosis in b-mode ultrasound: results of a pivotal multicenter validation study using artificial intelligence

Abstract Background Aortic stenosis (AS) is a highly prevalent and morbid condition, with moderate or severe AS present in 9% of patients over 75 years. Despite improved diagnostic and therapeutic methods, AS remains underdiagnosed, particularly in Black patients and underserved communities. Echocardiography (echo) is effective for detecting AS but requires expertise to quantify and interpret valve gradients and valve area. We hypothesized that a deep learning (DL) algorithm could be trained to detect AS severity using B-mode (non-Doppler) echo alone, the modality most likely to be available in point-of-care ultrasound (POCUS) studies. Here, we present the results of a multicenter pivotal trial to test whether artificial intelligence (AI) can help increase the detection of AS from B-mode echoes. Methods A convolutional neural network (CNN) was trained to classify the severity of aortic stenosis from 3 B-mode echo views of the aortic valve (parasternal long- and short-axis and apical 5-chamber). The training dataset had over 500,000 cine loops from 29,527 echoes in 26,981 patients. A fully crossed multireader multicase study was conducted using 220 echoes never seen during algorithm development. 5 level II-trained cardiologists (referred to as POCUS readers as they only reviewed B-mode clips) were presented with these echoes twice at least a month apart, once with and again without AI interpretation of AS severity. Readers identified 2 dichotomous severity levels (either "suggestive of moderate to severe AS" or not), with ground truth established by 3 level III-trained cardiology echo experts. While experts had access to full studies (including Doppler) to adjudicate severity, POCUS readers had no Doppler or measurements of any kind available. Sensitivity and specificity were compared for the 5 POCUS readers when aided by the AI algorithm vs unaided, with similar tests of inter-reader agreement. Results There was a statistically significant improvement in sensitivity (+5.5%, 95% CI [1.5%, 9.5%], p=0.007) with stable specificity (-0.3%, 95% CI [-3.6%, 3.0%], p=NS) when the 5 POCUS readers received the assistance of the AI software. Fig 1 shows 2,500 bootstrapping assessments to better show consistency of these findings. In addition, the POCUS inter-reader agreement (overall percent agreement) improved by approximately 7% (p<0.001), becoming comparable to that of expert readers (Fig 2). Conclusions In a comprehensive multireader pivotal trial, an AI algorithm improved the performance of POCUS cardiologist readers to identify significant AS from limited B-mode echoes as might be obtained in screening or outreach settings. Sensitivity for detection of moderate-severe AS increased significantly by 5.5% with stable specificity. Inter-reader agreement improved to resemble that of expert cardiologists given access to full study information, including Doppler. AI may have a role in assisting detection of significant AS from limited B-mode echoes.Fig 1Fig 2

Beyond telehealth in heart failure, how a nurse-led mobile team unit improves management and reduces re-admission in elderly patients living in a rural area

Abstract Introduction Telehealth plays a crucial role in improving access to healthcare for elderly patients with heart failure (HF), particularly those who live in under-resourced geographic areas, have physical disabilities, or have difficulties with transportation. However, extending and improving telehealth faces significant obstacles, primarily due to its inadequacy to fully assess a patient's clinical status. While some components of HF can be measured remotely, others, such as cardiac and lung examinations, require in-person clinical evaluation. This leads to imprecise assessments of HF severity, excessive medical consultations, and inappropriate emergency transfers or hospitalization. We conducted an evaluation of a specialized mobile team unit (MTU) for HF care in a rural area. The team consisted of nurses trained in performing electrocardiograms (ECGs) and point-of-care ultrasound (POCUS) to extend telemonitoring services to elderly patients with HF in the comfort of their homes. This approach offers a direct and optimal evaluation of the patient's condition. Purpose This study aimed to evaluate the added value of an MTU in assessing and optimizing treatment for HF in elderly patients, ultimately leading to decreased hospitalization or medical request rates. Materials and methods This retrospective analysis examined data from elderly patients diagnosed with HF, who participated in a 6-month telemonitoring program, and received MTU visits. MTU was activated by the telemonitoring team, in patients presenting signs of decompensation, with an imprecise assessment of severity based on digital data only. Results During six months, 165 elderly patients were included in the telemonitoring platform after index HF hospitalization. The mobile team traveled over 3,040 kilometers in a rural area with limited cardiological care. They visited 84 patients (50.9%), offering personalized education and physical assessments to all of the patients, 45% received additional imaging (EKG, POCUS). This resulted in 30% therapeutic adjustments, 90% fewer General practitioner (GP) /Cardiologist consultations and 54% avoided readmissions: 20% of hospitalizations were avoided immediately and 34% likely avoided in the near future, demonstrating the intervention's 80% effectiveness. Conclusion Monitoring heart failure (HF) in elderly patients can be challenging, especially in rural areas with limited access to care, few caregivers, cognitive impairments, or difficulty using e-health platforms. This study emphasizes the benefits of a nurse-led mobile team unit in providing a reliable direct assessment of HF severity. This home intervention provides education, strengthens the decision-making capacity of the remote monitoring platform, assists with patient management, and significantly reduces the readmission rate.

ValveVision AI - a multimodal language model for qualitative reporting of the aortic valve in echocardiography

Abstract Background The precise assessment of the aortic valve via echocardiography is critical for early detection and management of aortic valve diseases. Until recently, previous studies have examined machine learning models to estimate individual measurements and severity of aortic stenosis (AS) from echocardiographic images. These image processing algorithms, while precise in their narrow focus, fall short in mirroring the holistic and interconnected clinical judgment typical of human echocardiographers in producing a qualitative report. Large language models (LLMs), particularly image-to-text multi-modal LLMs, are a fundamental advance in the field of deep learning with implications for a host of applications in medical imaging. They promise to encapsulate not just discrete data points typical in traditional machine learning, but also the complex contextual interrelations in clinical diagnosis. Methods In this study, a large-scale heterogeneous database of echocardiographic images containing over 90,681 studies with textual descriptors of the aortic valve was used to train a single, image-to-text multimodal LLM called ValveVision AI. The ground truth textual summaries were drafted by level III echocardiographers in a clinical setting between 2015-2020. BLEU and ROUGE score was calculated. The models were retrospectively assessed on a holdout dataset. Reviewing physicians compared the generated summary to the ground truth and binarily agreed or rejected it. Receiver Operating Characteristics (ROC) for distinct pathologies were also assessed (Figure I). Results ValveVision AI performed with a BLEU score of 0.45 and a ROUGE score of 0.49. The performance of the model in reporting on classification of moderate/severe vs none/mild AS in concordance with the validation protocol described above achieved a specificity of 91.98% and a sensitivity of 83.89%, along with more precise qualitative description. Qualitatively, the model exhibited the capability of zero-shot learning in certain instances, however, this result remains an area of exploration. Conclusion This study represents to our knowledge, the first attempt at an image-representation to text-tokenizer deep learning model architecture to mimic the thought and subtlety of echocardiographic qualitative analysis of the aortic valve. The results suggest that this multimodal LLM has sufficient accuracy to create a preliminary textual summary of the aortic valve that, if paired with a point of care ultrasound (POCUS) device in a primary care setting, may facilitate case triage, increase efficiency, and determine a more precise care pathway for patients.

Pyogenic Liver Abscess and the Important Role of Point-of-Care Ultrasound (POCUS) in Daily Practice: A Report of Two Cases

Pyogenic Liver Abscess and the Important Role of Point-of-Care Ultrasound (POCUS) in Daily Practice: A Report of Two Cases

Evaluating the impact of structured POCUS training during internal medicine clerkship and residency training

Background: Point of Care Ultrasound (POCUS) is a vital tool in rheumatology for detecting pathologies like osteophytes and joint effusion. Its integration into rheumatology electives during internal medicine clerkship and residency is limited, despite its emphasis in pre-clinical years. Methods: In this QIRB-approved, single-center, prospective study (2022–2023), third- and fourth-year medical students and internal medicine residents in a two-week rheumatology elective voluntarily completed online surveys. These surveys assessed their confidence using POCUS in rheumatology, using a 5-point Likert scale. Results: A survey of 25 residents and 10 medical students found that 84% of residents and 90% of students rated POCUS training as valuable or very valuable. Both groups felt more confident identifying knee joint effusion (average scores: 3.5 for students, 2.6 for residents) compared to other ultrasound techniques and pathologies. Confidence was lower in hip ultrasounds (2.20 for students, 1.68 for residents) and chondrocalcinosis identification (2.20 for students, 1.76 for residents). Among participants, 28% of residents and 70% of students had prior informal POCUS training. Previous training significantly increased comfort levels, with average scores of 2.86 for students and 2.30 for residents, compared to 2.69 and 1.91 for those without prior training (P-values: <0.001). Conclusion: Prior experience significantly enhances confidence and comfort, reinforcing the need for early, comprehensive, and targeted POCUS training in medical curricula to address proficiency gaps. Keywords: Education, medical, undergraduate, rheumatology, point-of-care systems, ultrasonography

Study on the Consistency of Point-of-Care Ultrasound and Chest X-ray in the Diagnosis of Postoperative Thoracic Abnormalities in Children with Congenital Heart Disease

Objective: This study aimed to explore the consistency of point-of-care ultrasound (POCUS) and chest X-ray in the diagnosis of postoperative thoracic abnormalities in children with congenital heart disease. Methods: The clinical data of 68 children with congenital cardiosurgery in our hospital from January 2021 to August 2024 were retrospective analyzed. Six children were excluded, and 62 cases were finally included. POCUS was performed 24 hours after surgery. After the examination of POCUS, chest X-ray examination was conducted. The results of POCUS and chest X-ray examinations in children, as well as the clinical incidence of postoperative thoracic abnormalities were recorded. The effect of POCUS and chest X-ray in the diagnosis of postoperative thoracic abnormalities was compared. Results: POCUS had slightly higher diagnostic sensitivity of pleural effusion and atelectasis than chest X-ray. The sensitivity of POCUS in diagnosing pulmonary edema was consistent with that of chest X-ray. However, POCUS had slightly lower sensitivity in diagnosing pneumothorax than chest X-ray. The specificity of POCUS in diagnosing pneumothorax and atelectasis was consistent with that of chest X-ray. However, POCUS had slightly higher specificity in the diagnosis of pleural effusion and pulmonary edema than chest X-ray. The kappa values of POCUS and chest X-ray in diagnosing pleural effusion, pneumothorax, atelectasis and pulmonary edema were 0.546, 0.565, 0.502 and 0.701, respectively. Conclusion: POCUS and chest X-ray examinations have good consistency in the diagnosis of postoperative thoracic abnormalities in children with congenital heart disease.

Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study.

Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals' and students' knowledge, image interpretation skills, and clinical acumen. This study aimed to (1) establish an assessment instrument gauging nurses' competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses' PoCUS training needs and evaluate its content and appearance validity. We will conduct a methodological study of technological production guided by Rogers' diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses' competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. PRR1-10.2196/58030.

The Role of Neonatal Nurse Practitioners in the Implementation of a Bedside Point-of-Care Ultrasound Program.

Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described. To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs. In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols. The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators. NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers.

Exploring the use of point-of-care ultrasound by pelvic health physiotherapists in the UK

National and international surveys have highlighted point-of-care ultrasound (PoCUS) as an emergent technology that is being utilized by physiotherapists across a variety of clinical specialities. It confers advantages beyond traditional physiotherapy assessment and increases treatment options for patients with pelvic health conditions. What is not known is how pelvic health physiotherapists are routinely using PoCUS, or the barriers and enablers to its use that exist specifically within this population. The aim of this service evaluation was to explore the current use of PoCUS by pelvic health physiotherapists who are part of the POGP professional network to identify barriers and enablers to wider use within clinical practice across the UK. An online survey with both multiple-choice and free-text responses was shared. Questions covered four domains of interest: (1) demographic and professional characteristics; (2) current use of PoCUS; (3) perceived barriers and enablers; and (4) training. One hundred and two pelvic health physiotherapists with varied levels of experience responded from different sectors and areas of the UK. Only 30.4% reported routine use of PoCUS in their clinical practice despite consensus that PoCUS is an important tool for the rehabilitation of pelvic health conditions. Most barriers to the use of PoCUS identified could be linked to resource limitations, training or lack of support, and were also reflected in suggestions for enablers. Most users had formal training and felt that this had been sufficient to be competent in using PoCUS in their service. Physiotherapists recognize the advantages that PoCUS offers for rehabilitation in pelvic health populations, but are often unable to access the equipment or training required. Ongoing support after training is needed to ensure that users maintain confidence and competence, especially as many work as independent practitioners and are without a direct peer network. Updates to national recommendations or guidelines to include PoCUS as a recommended tool within rehabilitation may provide the impetus needed to support its adoption across more public healthcare settings.

An [illustrative] update on pediatric emergency ultrasound: part 3 - cerebral, musculoskeletal and other applications.

Point-of-care ultrasound (POCUS) plays an essential role in pediatric emergency medicine by improving diagnostics and procedural safety. The role of POCUS in the care of pediatric patients in the emergency department has expanded considerably in recent years. Cranial and musculoskeletal imaging has significant potential, yet POCUS has also become a vital tool for common procedures, such as central and difficult peripheral intravenous access. The purpose of this article is to provide an overview of pediatric POCUS applications for cranial, small parts (head, eyes, nose, throat, and soft tissue), musculoskeletal, and common procedural applications, forming the third part of the series.

Implementation of Point-of-Care Ultrasound (PoCUS) in Geisinger Health System

Implementation of Point-of-Care Ultrasound (PoCUS) in Geisinger Health System

Point-of-Care Ultrasound for the General Pediatric Resident: A Needs Assessment.

Point-of-care ultrasound (POCUS) is a valuable tool in pediatric care, but formalized education on POCUS is not a standard part of pediatric residency. Our primary objective was to conduct a needs assessment to determine pediatric residents' attitudes toward ultrasound education. A Likert scale-based survey was distributed to residents at 48 pediatric residency programs. Respondents were asked to rate their agreement to statements about ultrasound education at their respective programs. Participants were also asked to rank ultrasound indications in order of importance. Ninety-seven survey responses were included in the final data set. Sixty percent of respondents had not performed any ultrasound scans during residency. Ninety-two percent of respondents indicated an interest in ultrasound training during residency and that they desired a formal POCUS curriculum. Eighty-one percent of residents indicated that having more ultrasound education would make their programs more attractive to applicants. Pediatric residents recognize the utility of POCUS and desire additional education during training.

Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents. To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents. A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies. PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs). Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions. We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures. Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.

Nuts and bolts of lung ultrasound: utility, scanning techniques, protocols, and findings in common pathologies.

Point of Care ultrasound (POCUS) of the lungs, also known as lung ultrasound (LUS), has emerged as a technique that allows for the diagnosis of many respiratory pathologies with greater accuracy and speed compared to conventional techniques such as chest x-ray and auscultation. The goal of this narrative review is to provide a simple and practical approach to LUS for critical care, pulmonary, and anesthesia providers, as well as respiratory therapists and other health care providers to be able to implement this technique into their clinical practice. In this review, we will discuss the basic physics of LUS, provide a hands-on scanning technique, describe LUS findings seen in normal and pathological conditions (such as mainstem intubation, pneumothorax, atelectasis, pneumonia, aspiration, COPD exacerbation, cardiogenic pulmonary edema, ARDS, and pleural effusion) and also review the training necessary to achieve competence in LUS.

When flank pain leads to fainting: a case of a ruptured angiomyolipoma diagnosed by point-of-care ultrasound

BackgroundAcute flank pain is a common presentation in the Emergency Department (ED). Point-of-care ultrasound (PoCUS) has emerged as an invaluable tool in the evaluation of acute flank pain and provides real-time images resulting in the early identification of the underlying pathology.Case ReportHere we report a case of a young lady presented to the ED with a complaint of right flank pain followed by a syncopal episode. The diagnosis of ruptured angiomyolipoma was made using a PoCUS and an immediate consult to interventional radiology and urology was provided.ConclusionThis case highlights the importance of PoCUS in assessing patients presented to the ED with acute flank pain. Its incorporation into clinical practice promises to revolutionize the approach to renal emergencies, emphasizing its important role in delivering timely and effective care.

Mistaken Identity: Misidentification of Other Vascular Structures as the Inferior Vena Cava and How to Avoid It.

While point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) is broadly perceived as having value in intravascular volume status assessment, this has not been borne out in large-scale meta-analyses containing heterogenous populations of acutely ill patients. While the limitations of IVC POCUS could be largely due to the complexity of the relationship between IVC appearance and volume status, another confounder not widely appreciated is the ease with which the aorta or right hepatic vein (RHV) can be mistaken for the IVC. While misidentification of the aorta as the IVC has been recognized elsewhere, misidentification of the RHV for the IVC has not and, in our experience, occurs frequently, even in the hands of experienced sonographers. We demonstrate how these errors occur and provide guidance on how to systematically avoid them.

The utility of point-of-care ultrasound in critical care nephrology.

Point-of-care ultrasonography (POCUS) is gaining heightened significance in critical care settings as it allows for quick decision-making at the bedside. While computerized tomography is still considered the standard imaging modality for many diseases, the risks and delays associated with transferring a critically ill patient out of the intensive care unit (ICU) have prompted physicians to explore alternative tools. Ultrasound guidance has increased the safety of invasive procedures in the ICU, such as the placement of vascular catheters and drainage of collections. Ultrasonography is now seen as an extension of the clinical examination, providing quick answers for rapidly deteriorating patients in the ICU. The field of nephrology is increasingly acknowledging the value of diagnostic point-of-care ultrasound (POCUS). By employing multi-organ POCUS, nephrologists can address specific queries that arise during the diagnosis and treatment of patients with acute kidney injury. This approach aids in ruling out hydronephrosis and offers immediate information on hemodynamics, thereby consolidating patient data and facilitating the development of personalized treatment strategies.

Retrospective Review of the Image Quality of Monoplane Transesophageal Echocardiography in Prehospital Out-Of-Hospital Cardiac Arrest: A Single Center Pilot Study

ABSTRACT OBJECTIVES Out of Hospital Cardiac Arrest (OHCA) is a frequently encountered pathology with resultant poor outcomes in the majority of patients. Echocardiography has been utilized to help guide clinical decision making and monitor effectiveness of resuscitative efforts. Transthoracic echocardiography (TTE) the mainstay of point-of-care ultrasound (POCUS) real time resuscitative imaging has limitations, most notably is the disruption of closed chest compressions. Trans-esophageal echocardiography (TEE) is an emerging technology in emergency care and can potentially overcome these limitations but image quality and accuracy of use in the prehospital environment remains unknown. Our primary objective is to identify the accuracy of Emergency Medical Services (EMS) fellow physicians in performing TEE via the identification of key cardiac structures. Secondarily we assess image quality as well as accuracy on cardiac activity interpretation as compared to TEE-experienced cardiologists. METHODS A pilot study using descriptive analysis of a retrospective case-series with specific focus on inter-rater reliability as well as pragmatic management alterations based on real-time image interpretation by EMS physicians. After focused education, 13 patients were eligible for prehospital TEE who suffering OHCA from July 2022-June 2023. Ultrasound (US) images were interpreted by EMS fellow physicians and over-read by cardiologists with specific focus on inter-rater reliability. After collection of patients presenting data and US images, analysis was performed. RESULTS Of 13 patients initially screened, 10 patients were included in a study with a median age of 50 years old (41-70). Three patients were excluded due to equipment malfunction or insufficient image capture. An interrater reliability identified a kappa of 0.96 with respect to identification of cardiac structures and a kappa of 0.65 for identification of cardiac activity. CONCLUSIONS In this small study of prehospital TEE, EMS fellow physicians had high inter-rater reliability in image interpretation pertaining to anatomy and cardiac activity when compared with cardiologists. Further research is needed to determine its efficacy, safety, and widespread application in the prehospital setting.

Point-of-care ultrasound in resource-limited environments: a review

Ultrasound is a standard assessment modality in hospital and prehospital settings. It is becoming more accessible in remote, austere and resource-limited environments. Aim: This article aims to review the literature on the use of point-of-care ultrasound (POCUS) imaging in low- to medium-income countries (LMICs) and by practitioners working in remote and austere out-of-hospital environments. Methods: Fifteen articles published between 2019 and 2023 found via PubMed were identified and analysed. Results: The 15 papers present the use of ultrasound imaging by practitioners in LMICs: six were systemic reviews; five were narrative reviews; two were randomised clinical trials; and two were case studies. Conclusions: Few articles focusing on POCUS use in LMICs were published over the five-year period. However, the number of publications increased over the years. Of the 15 studies in this review, six (40%) were systematic reviews, five (33%) were narrative reviews, two (13%) were random clinical trials and two (13%) were case studies. All studies were conducted in district hospitals or other resource-limited environments. The studies have revealed a significant increase in POCUS use over the past few years, with the majority of the devices now being smartphone-based. This is a promising development in POCUS use in austere environments.