Evaluation of the American college of surgeons thyroid and parathyroid ultrasound course: Results of a web-based survey

Head and Neck Ultrasound Utilization Rates: 2012 to 2019

Objective

We measured utilization of clinician-performed head and neck ultrasound among otolaryngologists, endocrinologists, and general surgeons, using Medicare Provider Utilization and Payment Data.

Study Design

Retrospective analysis of Medicare billing database.

Setting

University.

Methods

For each year, the files were filtered to include 4 provider types: Diagnostic Radiology (DR), Endocrinology (ENDO), General Surgery (GS), and Otolaryngology (OTO). Billable procedures are listed by Healthcare Common Procedure Coding System code and a filter was applied to include 76536 Ultrasound, soft tissues of the head and neck.

Results

In 2019, OTOs submitted charges for 2.1% of all head and neck diagnostic ultrasounds (76536) performed on Medicare beneficiaries. For each year 2012 to 2019, DRs submitted the most charges, followed by ENDOs, and then OTO and GS. Charges for all groups increased in a proportional manner across the 8-year period. 14.5% of OTOs submitted more than 100 charges apiece during 2019, that is, "super users." The percentage of super users within each specialty increased from 2012 to 2019. Overall, the data support an ever-increasing use of head and neck ultrasound (HNUS) among all provider types.

Conclusion

Even with increased use among OTOs, this specialty only accounted for a small percentage of head & neck diagnostic ultrasounds performed on Medicare beneficiaries in 2019. Changes in volume of nonradiology point-of-care HNUS was not associated with changes in DR volume. A greater proportion of OTOs than DRs are "super users" among the ultrasound users within their specialty, performing more than 100 exams/year.

Level of Evidence

V.

Improving on the Do-It-Yourself Ultrasound-Guided Fine-Needle Aspiration Simulation Phantom

The increasing use of ultrasound (US) for the diagnostic workup of thyroid lesions has subsequently been met with an increasing demand for effective US and US-guided fine-needle aspiration models. Although numerous do-it-yourself phantoms have been previously described, to our knowledge, this is the first to describe a more realistic US thyroid model using inexpensive consumer-grade materials. A simple phantom was developed and successfully used to obtain US images that realistically mimic thyroid anatomy and echogenicity. The phantom was constructed for a total cost of $6.69. It served as an inexpensive and anatomically realistic means to simulate thyroid US and US-guided fine-needle aspiration.

Management of pericardial fluid in blunt trauma: Variability in practice and predictors of operative outcome in patients with computed tomography evidence of pericardial fluid

BACKGROUND

The objectives of this study were to assess current variability in management preferences for blunt trauma patients with pericardial fluid, and to identify characteristics associated with operative intervention for patients with pericardial fluid on admission computed tomography (CT) scan.

METHODS

This was a mixed-methods study of blunt trauma patients with pericardial fluid. The first portion was a research survey of members of the Eastern Association for the Surgery of Trauma conducted in 2016, in which surgeons were presented with four clinical scenarios of blunt trauma patients with pericardial fluid. The second portion of the study was a retrospective evaluation of all blunt trauma patients 14 years or older treated at our Level I trauma center between January 1, 2010, and November 1, 2015, with pericardial fluid on admission CT scan.

RESULTS

For the survey portion of our study, 393 surgeons responded (27% response rate). There was significant variability in management preferences for scenarios depicting trace pericardial fluid on CT with concerning hemodynamics, and for scenarios depicting hemopericardium intraoperatively. For the separate retrospective portion of our study, we identified 75 blunt trauma patients with pericardial fluid on admission CT scan. Seven underwent operative management; six of these had hypotension and/or electrocardiogram changes. In multivariable analysis, pericardial fluid amount was a significant predictor of receiving pericardial window (relative risk for one category increase in pericardial fluid amount, 3.99, 95% confidence interval, 1.47-10.81) but not of mortality.

CONCLUSION

There is significant variability in management preferences for patients with pericardial fluid from blunt trauma, indicating a need for evidence-based research. Our institutional data suggest that patients with minimal to small amounts of pericardial fluid without concerning clinical findings may be observed. Patients with moderate to large amounts of pericardial fluid who are clinically stable with normal hemodynamics may also appear appropriate for observation, although confirmation in larger studies is needed. Patients with hemodynamic instability should undergo operative exploration.

LEVEL OF EVIDENCE

Therapeutic/care management study, level IV.