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Monteiro AC, França de Santana T, Morais M, Santos C, Aurélio J, Santos I, Cruz S, Vázquez D, Ferreira Arroja S, Mariz J. Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine. Cureus 2024; 16:e55573. [PMID: 38576627 PMCID: PMC10994179 DOI: 10.7759/cureus.55573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
This narrative review explores the application of point-of-care ultrasound (POCUS) in palliative care and its feasibility in home care settings. POCUS has the potential to streamline diagnostic strategies without patient transfer to the hospital, expedite timely symptomatic relief, and reduce complications from specific palliative interventions. The advent of handheld ultrasound devices has made it an attractive diagnostic and interventional adjunct in acute palliative care. POCUS has gained widespread acceptance as part of routine care in emergency medicine and intensive care, guiding certain procedures and increasing their safety. The modernization and miniaturization of ultrasound equipment have made ultra-portable devices available, allowing for better-quality images at affordable prices. Handheld devices have the potential to revolutionize everyday clinical practice in home-based palliative care, contributing to important bedside clinical decisions. Palliative care patients often require diagnostic examinations in the last months of their lives, with CT being the most frequently performed imaging procedure. However, CT imaging is associated with high costs and burdens, leading to increased suffering and impaired quality of life. Clinical ultrasound, a dialogic imaging modality, offers a safer and more efficient approach to palliative care. POCUS applications, which are cost-effective, non-invasive, and well-tolerated, can be used to improve patient satisfaction and diagnostic understanding. POCUS is a valuable tool in palliative care, improving diagnostic accuracy and reducing the time to diagnosis for various pathologies. It is a standard of care for many procedures and improves patient safety. However, there are limitations to POCUS in palliative care, such as operator-dependent examination variability and limited availability of trained professionals. To overcome these limitations, palliative care physicians should receive mandatory training in POCUS, which can be incorporated into the core curriculum. Additionally, ultrasound teleconsulting can assist less experienced examiners in real-time examinations. The literature on POCUS in palliative care is limited, but research on patient-oriented outcomes is crucial. POCUS should be considered a supplement to good clinical reasoning and regulated radiological evaluations.
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Affiliation(s)
| | | | - Mariana Morais
- Internal Medicine Department, Centro Hospitalar Lisboa Central - Hospital São José, Lisboa, PRT
| | - Catarina Santos
- Internal Medicine Department, Hospital Garcia de Orta, Almada, PRT
| | - João Aurélio
- Internal Medicine Department, Centro Hospitalar do Algarve - Unidade Hospitalar de Portimão, Portimão, PRT
| | - Inês Santos
- Internal Medicine Department, Centro Hospitalar Lisboa Ocidental - Hospital Egas Moniz, Lisboa, PRT
| | - Sofia Cruz
- Internal Medicine Department, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | | | | | - José Mariz
- Emergency Department, Hospital de Braga, Braga, PRT
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, PRT
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2
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Popat A, Harikrishnan S, Seby N, Sen U, Patel SK, Mittal L, Patel M, Vundi C, Patel Y, Babita, Kumar A, Nakrani AA, Patel M, Yadav S. Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52371. [PMID: 38694948 PMCID: PMC11062642 DOI: 10.7759/cureus.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 05/04/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
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Affiliation(s)
- Apurva Popat
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
| | | | - Niran Seby
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Udvas Sen
- Internal Medicine, Agartala Government Medical College, Agartala, IND
| | - Sagar K Patel
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Lakshay Mittal
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Mitkumar Patel
- Internal Medicine, Mahatma Gandhi Mission (MGM) Medical College, Navi Mumbai, IND
| | - Charitha Vundi
- Internal Medicine, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, IND
| | - Yashasvi Patel
- Internal Medicine, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Babita
- Internal Medicine, Uzhhorod National University, Uzhhorod, UKR
| | - Ashish Kumar
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Akash A Nakrani
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Surat, IND
| | - Mahir Patel
- Medical School, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Sweta Yadav
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
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3
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Wubben BM, Yun HI. The Performance Characteristics of Handheld, Non-Piezoelectric Point-of-Care Ultrasound (POCUS) in the Emergency Department. Diagnostics (Basel) 2023; 14:17. [PMID: 38201326 PMCID: PMC10795712 DOI: 10.3390/diagnostics14010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The use of handheld point-of-care ultrasound (HH-POCUS) platforms is rapidly increasing, but the diagnostic performance of HH-POCUS in the emergency department (ED) has not been well-studied. For a period of one year, only a HH-POCUS system that uses a non-piezoelectric array (Butterfly iQ+™) was available for clinical POCUS examinations in our ED. We performed a retrospective observational study of patients who underwent cardiac, thoracic, renal, biliary, or lower extremity venous (DVT) examinations from November 2021-November 2022 and calculated performance characteristics of HH-POCUS relative to radiology imaging. A total of 381 HH-POCUS studies were evaluated. Cardiac image quality was significantly lower than lung (p = 0.002). Over half of the studies (213/381) had imaging available for comparison, and HH-POCUS identified 86.5% (32/37, (95%CI) 70.4-94.9) of prespecified emergent diagnoses, including acute cholecystitis, severely reduced left ventricular ejection fraction, pericardial effusion or tamponade, moderate or larger pleural effusion, pneumothorax, moderate or larger hydronephrosis, and DVT. For less emergent diagnoses, 84.3% (43/51, (95%CI) 70.9-92.5) were identified. Overall, HH-POCUS using a non-piezoelectric array showed modest real-world performance in the ED for cardiac, thoracic, renal, biliary, and DVT examinations. HH-POCUS may be inadequate to rule out some common ED diagnoses, but had good specificity for certain conditions such as pericardial effusion.
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Affiliation(s)
- Brandon Michael Wubben
- Department of Emergency Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Hae In Yun
- Carver College of Medicine, University of Iowa, 375 Newton Road, Iowa City, IA 52242, USA;
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Jarman RD, McDermott C, Colclough A, Bøtker M, Knudsen L, Harris T, Albaroudi B, Albaroudi O, Haddad M, Darke R, Berry E, Breslin T, Fitzpatrick G, Flanagan L, Olusanya O, Craver D, Omar A, Simpson T, Cherian N, Dore M, Prosen G, Kay S, Villén-Villegas T, Gargani L, Carley S, Woo M, Dupriez F, Hussain A, Via G, Connolly JA, Peck M, Melniker L, Walden A, Attard Biancardi MA, Żmijewska-Kaczor O, Lalande E, Geukens P, McLaughlin R, Olszynski P, Hoffmann B, Chin E, Muhr C, Kim DJ, Mercieca A, Shukla D, Hayward S, Smith M, Gaspari R, Smallwood N, Pes P, Tavazzi G, Corradi F, Lambert M, Morris C, Trauer M, Baker K, Bystrzycki A, Goudie A, Liu R, Rudd L, Dietrich CF, Jenssen C, Sidhu PS. EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e1-e24. [PMID: 36228631 DOI: 10.1055/a-1882-5615] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIMS To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). METHODS We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of "strongly agree" and "agree" on the Likert scale responses. FINDINGS AND RECOMMENDATIONS One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3-5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6-8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). CONCLUSION These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.
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Affiliation(s)
- Robert David Jarman
- Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
| | - Cian McDermott
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anna Colclough
- Emergency Medicine, University Hospital Lewisham, London, United Kingdom of Great Britain and Northern Ireland
| | - Morten Bøtker
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Prehospital Emergency Medical Services, Central Denmark Region, Viborg, Denmark
| | - Lars Knudsen
- Department of Anaesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Tim Harris
- Emergency Medicine, Queen Mary University of London, United Kingdom of Great Britain and Northern Ireland
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Omar Albaroudi
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mahmoud Haddad
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Robert Darke
- Emergency Medicine and Intensive Care Medicine, Health Education England North East, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Edward Berry
- Emergency Medicine, Torbay Hospital, Torquay, United Kingdom of Great Britain and Northern Ireland
| | - Tomas Breslin
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Ireland
| | | | - Leah Flanagan
- Emergency Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Olusegun Olusanya
- Intensive Care Medicine, University College Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Dominic Craver
- Emergency Medicine, The Royal London Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Adhnan Omar
- Respiratory Medicine, University Hospital Lewisham, London, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Simpson
- Respiratory Medicine, Lewisham and Greenwich NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Nishant Cherian
- Emergency Medicine, The Alfred Emergency & Trauma Centre, Melbourne, Australia
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom of Great Britain and Northern Ireland
| | - Martin Dore
- Emergency Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Gregor Prosen
- Center for Emergency Medicine, University Medical Centre Maribor, Slovenia
| | - Sharon Kay
- Cardiac Physiology and Echocardiography, The University of Sydney, Australia
| | | | - Luna Gargani
- Cardiology, Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Simon Carley
- Emergency Medicine, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
- Emergency Medicine, Manchester Metropolitan University, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Michael Woo
- Emergency Medicine, University of Ottawa, Canada
- Emergency Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Florence Dupriez
- Emergency Medicine, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Arif Hussain
- Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gabriele Via
- Anesthesiology, Intensive Care and Pain Medicine, Istituto Cardiocentro Ticino Ente Ospedaliero Cantonale, Lugano, Switzerland, Pavia, Italy
| | - James Anthony Connolly
- Emergency Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Marcus Peck
- Anaesthesia and Intensive Care, Frimley Park Hospital NHS Trust, Frimley, United Kingdom of Great Britain and Northern Ireland
| | - Larry Melniker
- Emergency Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, United States
| | - Andrew Walden
- Acute and Intensive Care Medicine, Royal Berkshire Hospital, Reading, United Kingdom of Great Britain and Northern Ireland
- Acute Medicine and Intensive Care Medicine, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | | | - Olga Żmijewska-Kaczor
- Emergency Medicine, Royal Cornwall Hospital, Truro, United Kingdom of Great Britain and Northern Ireland
| | - Elizabeth Lalande
- Emergency Medicine, Centre Hospitalier de l'Université Laval, Sainte-Foy, Canada
| | - Paul Geukens
- Intensive Care Medicine, Hopital de Jolimont, Haine-Saint-Paul, Belgium
| | - Russell McLaughlin
- Emergency Medicine, Royal Victoria Hospital, Belfast, United Kingdom of Great Britain and Northern Ireland
- Medical Director, Northern Ireland Ambulance Service, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Paul Olszynski
- Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Beatrice Hoffmann
- Emergency Department, Harvard Medical School Department of Emergency Medicine Beth Israel Deaconess Medical Center, Boston, United States
| | - Eric Chin
- Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, United States
| | - Christopher Muhr
- Emergency Medicine and Internal Medicine, Capio Sankt Gorans Sjukhus, Stockholm, Sweden
| | - Daniel J Kim
- Emergency Medicine, The University of British Columbia, Vancouver, Canada
- Emergency Medicine, Vancouver General Hospital, Vancouver, Canada
| | | | | | - Simon Hayward
- Physiotherapy, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom of Great Britain and Northern Ireland
| | - Michael Smith
- School of Healthcare Sciences, Cardiff University College of Biomedical and Life Sciences, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Romolo Gaspari
- Emergency Medicine, UMass Memorial Medical Center, Worcester, United States
- Emergency Medicine, UMass Medical School, Worcester, United States
| | - Nick Smallwood
- Acute Medicine, East Surrey Hospital, Redhill, United Kingdom of Great Britain and Northern Ireland
| | - Philippe Pes
- Emergency Medicine, University Hospital Centre Nantes, France
| | - Guido Tavazzi
- Anesthesia and Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Clinico-Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia Facoltà di Medicina e Chirurgia, Pavia, Italy
| | - Francesco Corradi
- Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Michael Lambert
- Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, United States
| | - Craig Morris
- Intensive Care, Royal Derby Hospital, Derby, United Kingdom of Great Britain and Northern Ireland
| | - Michael Trauer
- Emergency Medicine, St Thomas' Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Kylie Baker
- Emergency Medicine, Ipswich Hospital, Ipswich, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Australia
| | - Adam Bystrzycki
- Emergency Medicine, The Alfred Emergency & Trauma Centre, Melbourne, Australia
- Department of Epidemiology & Preventive Medicine, Monash University, Clayton, Australia
| | - Adrian Goudie
- Emergency Medicine, Fiona Stanley Hospital, Murdoch, Australia
| | - Rachel Liu
- Emergency Medicine, Yale School of Medicine, New Haven, United States
| | - Lynne Rudd
- General Secretary, European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), London, United Kingdom of Great Britain and Northern Ireland
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Germany
| | - Paul S Sidhu
- Radiology, King's College London, United Kingdom of Great Britain and Northern Ireland
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5
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Lo H, Eder N, Boten D, Jenssen C, Nuernberg D. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8:E68-E76. [PMID: 36937375 PMCID: PMC10023243 DOI: 10.1055/a-1999-7834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/24/2022] [Indexed: 03/19/2023] Open
Abstract
Due to the severity of their disease, palliative care patients often present complex clinical symptoms and complaints like pain, shortness of breath, nausea, loss of appetite, and fatigue. Solely relying on the information available from the history and physical examination often causes uncertainty among palliative care physicians regarding treatment decisions during home visits, potentially leading to unnecessary hospitalizations or transfer to cross-sectional imaging in radiological practices. A rational approach is essential to avoid diagnostic aggressiveness while still providing the imaging information required for optimal palliative care. Bedside use of handheld ultrasound (HHUS) has the potential to expand the diagnostic and therapeutic spectrum in the case of symptom exacerbation but is still underutilized. In this review, we evaluate the potential uses of HHUS in home care settings to provide a more accurate diagnosis of the most common symptoms in palliative patients and to guide bedside interventions such as bladder catheterization, thoracentesis, paracentesis, venous access, and regional anesthesia. Specific training programs for ultrasound in palliative care are currently not available. Adequate documentation is warranted but fraught with technological and privacy issues. Expert supervision and quality assurance are necessary. Despite its limitation and challenges, we suggest that HHUS leads to improved clinical decision-making, expedited symptom relief, and reduced complications without burdening of the patient and costly transfer to hospital or specialty consultations.
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Affiliation(s)
- Hendra Lo
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine – Gastroenterology, Diabetology
and Hepatology, Vivantes Hospital Neukölln, Berlin,
Germany
- Correspondence Mr. Hendra Lo Brandenburg
Medical University Theodor Fontane, Institute for Clinical Ultrasound
(BICUS) and Faculty of Health Sciences Brandenburg, Fehrbelliner
Straße 3816816NeuruppinGermany+ 49
3391 3914710
,
| | - Nicole Eder
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - David Boten
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
| | - Christian Jenssen
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
- Department of Internal Medicine, Krankenhaus Märkisch Oderland,
Strausberg, Germany
| | - Dieter Nuernberg
- Brandenburg Medical University Theodor Fontane, Institute for Clinical
Ultrasound (BICUS) and Faculty of Health Sciences Brandenburg, Neuruppin,
Germany
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Harms C, Cushman T. Two Cases of Extensive Venous Thrombosis Incidentally Discovered With Bedside Ultrasound for Intravenous Access. A A Pract 2021; 15:e01529. [PMID: 34807872 DOI: 10.1213/xaa.0000000000001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Perioperative deep vein thrombosis (DVT) is a serious and increasingly common complication. While point-of-care ultrasound is commonly used in regional nerve blocks, central vascular access, and difficult peripheral vascular, access there are very few reports of DVT incidentally discovered by anesthesiologists. We report 2 cases of diagnosis of DVT that resulted from ultrasound for difficult peripheral venous access. In the course of ultrasound-guided procedures, anesthesiologists are in a position to incidentally discover DVT and potentially change management to reduce the likelihood of DVT leading to pulmonary embolism.
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Affiliation(s)
- Casey Harms
- From the Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon
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7
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Guarracino F, Vetrugno L, Forfori F, Corradi F, Orso D, Bertini P, Ortalda A, Federici N, Copetti R, Bove T. Lung, Heart, Vascular, and Diaphragm Ultrasound Examination of COVID-19 Patients: A Comprehensive Approach. J Cardiothorac Vasc Anesth 2021; 35:1866-1874. [PMID: 32624431 PMCID: PMC7289113 DOI: 10.1053/j.jvca.2020.06.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Lung ultrasound (LU) has a multitude of features and capacities that make it a useful medical tool to assist physicians contending with the pandemic spread of novel coronavirus disease-2019 (COVID-19) caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thus, an LU approach to patients with suspected COVID-19 is being implemented worldwide. In noncritical COVID-19 patients, 2 new LU signs have been described and proposed, the "waterfall" and the "light beam" signs. Both signs have been hypothesized to increase the diagnostic accuracy of LU for COVID-19 interstitial pneumonia. In critically ill patients, a distinct pattern of LU changes seems to follow the disease's progression, and this information can be used to guide decisions about when a patient needs to be ventilated, as occurs in other disease states similar to COVID-19. Furthermore, a new algorithm has been published, which enables the automatic detection of B-lines as well as quantification of the percentage of the pleural line associated with lung disease. In COVID-19 patients, a direct involvement of cardiac function has been demonstrated, and ventilator-induced diaphragm dysfunction might be present due to the prolonged mechanical ventilation often involved, as reported for similar diseases. For this reason, cardiac and diaphragm ultrasound evaluation are highly important. Last but not least, due to the thrombotic tendency of COVID-19 patients, particular attention also should be paid to vascular ultrasound. This review is primarily devoted to the study of LU in COVID-19 patients. The authors explain the significance of its "light and shadows," bearing in mind the context in which LU is being used-the emergency department and the intensive care setting. The use of cardiac, vascular, and diaphragm ultrasound is also discussed, as a comprehensive approach to patient care.
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Affiliation(s)
- Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Luigi Vetrugno
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy.
| | - Francesco Forfori
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Daniele Orso
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alessandro Ortalda
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Federici
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
| | - Roberto Copetti
- Emergency Department, Azienda Sanitaria Universitaria Friuli Centrale, Latisana General Hospital, Latisana, Italy
| | - Tiziana Bove
- Department of Medicine, Anesthesia and Intensive Care Clinic, University of Udine, Udine, Italy; Department of Anesthesia and Intensive care, University-Hospital of Udine, Italy, Udine, Italy
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8
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Malik AN, Rowland J, Haber BD, Thom S, Jackson B, Volk B, Ehrman RR. The Use of Handheld Ultrasound Devices in Emergency Medicine. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 9:73-81. [PMID: 33996272 PMCID: PMC8112245 DOI: 10.1007/s40138-021-00229-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/23/2022]
Abstract
Purpose of Review Ultraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these machines are becoming more common due to ease-of-use, extreme affordability, and improving technology. Recent Findings Images obtained with HHU are comparable to those obtained with traditional machines but create unique issues regarding billing and data management. HHU devices are increasingly used successfully to augment the education of practitioners-in-training, by emergency physicians in austere environments, and in the burgeoning fields of "tele-ultrasound" and augmented reality scanning. Summary This review seeks to describe the current state of use of HHU devices in the emergency department (ED) including device overview, institutional concerns, unique areas of use, recent literature since their adoption into clinical EM, and their future potential.
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Affiliation(s)
- Adrienne N Malik
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Jonathan Rowland
- Department of Emergency Medicine, University of California-Irvine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Brian D Haber
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Suite 6G, Detroit, MI USA
| | - Stephanie Thom
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Bradley Jackson
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Bryce Volk
- Department of Emergency Medicine, University of Kansas School of Medicine, 1450 Jayhawk Blvd, Lawrence, KS 66045 USA
| | - Robert R Ehrman
- Department of Emergency Medicine, Wayne State University School of Medicine, 4201 St. Antoine, Suite 6G, Detroit, MI USA
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Zieleskiewicz L, Lopez A, Hraiech S, Baumstarck K, Pastene B, Di Bisceglie M, Coiffard B, Duclos G, Boussuges A, Bobbia X, Einav S, Papazian L, Leone M. Bedside POCUS during ward emergencies is associated with improved diagnosis and outcome: an observational, prospective, controlled study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:34. [PMID: 33482873 PMCID: PMC7825196 DOI: 10.1186/s13054-021-03466-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/12/2021] [Indexed: 01/27/2023]
Abstract
Background Rapid response teams are intended to improve early diagnosis and intervention in ward patients who develop acute respiratory or circulatory failure. A management protocol including the use of a handheld ultrasound device for immediate point-of-care ultrasound (POCUS) examination at the bedside may improve team performance. The main objective of the study was to assess the impact of implementing such a POCUS-guided management on the proportion of adequate immediate diagnoses in two groups. Secondary endpoints included time to treatment and patient outcomes. Methods A prospective, observational, controlled study was conducted in a single university hospital. Two teams alternated every other day for managing in-hospital ward patients developing acute respiratory and/or circulatory failures. Only one of the team used an ultrasound device (POCUS group). Results We included 165 patients (POCUS group 83, control group 82). Proportion of adequate immediate diagnoses was 94% in the POCUS group and 80% in the control group (p = 0.009). Time to first treatment/intervention was shorter in the POCUS group (15 [10–25] min vs. 34 [15–40] min, p < 0.001). In-hospital mortality rates were 17% in the POCUS group and 35% in the control group (p = 0.007), but this difference was not confirmed in the propensity score sample (29% vs. 34%, p = 0.53). Conclusion Our study suggests that protocolized use of a handheld POCUS device at the bedside in the ward may improve the proportion of adequate diagnosis, the time to initial treatment and perhaps also survival of ward patients developing acute respiratory or circulatory failure. Clinical Trial Registration NCT02967809. Registered 18 November 2016, https://clinicaltrials.gov/ct2/show/NCT02967809.
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Affiliation(s)
- Laurent Zieleskiewicz
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France. .,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, 13005, Marseille, France.
| | - Alexandre Lopez
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Sami Hraiech
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Karine Baumstarck
- Centre D'Etudes et de Recherches sur les Services de Santé et Qualité, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France
| | - Bruno Pastene
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Mathieu Di Bisceglie
- Assistance Publique Hôpitaux de Marseille, Service d'Imagerie Médicale, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Benjamin Coiffard
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Gary Duclos
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Alain Boussuges
- Assistance Publique Hôpitaux de Marseille, Service des Explorations Fonctionnelles Respiratoires, Aix Marseille University, 13015, Marseille, France.,Center for Cardiovascular and Nutrition Research (C2VN), INSERM, INRA, Aix Marseille Université, 13005, Marseille, France
| | - Xavier Bobbia
- Intensive Care Unit, Department of Anesthesiology, Emergency and Critical Care Medicine, University Hospital Nîmes, 30000, Nîmes, France
| | - Sharon Einav
- Surgical Intensive Care Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Laurent Papazian
- Assistance Publique Hôpitaux de Marseille, Service de Médecine Intensive - Réanimation, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
| | - Marc Leone
- Assistance Publique Hôpitaux de Marseille, Department of Anesthesiology and Intensive Care, Hôpital Nord, Aix Marseille University, 13015, Marseille, France
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Are pocket sized ultrasound devices sufficient in the evaluation of lung ultrasound patterns and aeration scoring in pulmonary ICU patients? J Clin Monit Comput 2020; 35:1491-1499. [PMID: 33170405 PMCID: PMC7653453 DOI: 10.1007/s10877-020-00617-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/02/2020] [Indexed: 12/16/2022]
Abstract
Lung ultrasound (LUS) is a practical diagnostic tool for several lung pathologies. Pocket sized USG devices (PSUDs) are more affordable, accessible, practical, and learning to use them is easier than standard ultrasound devices (SUDs). Their capability in image quality have been found as comparable with standard USG machines. Studies have been showing that these devices can be useful as much as SUDs in the evaluation of heart, abdomen, vascular structures, diaphragm and optic nerve. The aim of this study is to compare PSUD with a standard ultrasound devices (SUD) in the evaluation of LUS patterns such as alveolar, interstitial syndromes and lung aeration score (LAS). Study performed in an University Hospital Pulmonary ICU. All patients older than 18 years old were included in this study. The sector probe of SUD (Vivid-Q) and PSUD (Vscan) were used for investigation of A lines, interstitial (B lines), alveolar syndromes (consolidation, hepatisation, air bronchograms) and pleural effusion. 33 patients were included in the study. When PSUD was compared with SUD in terms of total B2 count, and LAS in the right, left and both lung, there was an agreement without proportional bias according to Bland Altman test. There was also good inter class correlation coefficient value as greater than 0.8 and 0.7 between two physicians in terms of counting of total B1, B2, total B lines and calculating of total LAS for SUD and PSUD respectively. PSUDs is a reliable and valid method for evaluation of LUS patterns like SUDs.
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Mancusi C, Carlino MV, Sforza A. Point-of-care ultrasound with pocket-size devices in emergency department. Echocardiography 2019; 36:1755-1764. [PMID: 31393640 DOI: 10.1111/echo.14451] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound is a useful tool for clinicians in the management of patients. Particularly in emergency department, the role of point-of-care ultrasound is strongly increasing due to the need for a rapid assessment of critically ill patients and to speed up the diagnostic process. Hand-carried ultrasound devices are particularly useful in emergency setting and allow rapid assessment of patient even in prehospital setting. This article will review the role of point-of-care ultrasonography, performed with pocket-size devices, in the management of patients presenting with acute onset of undifferentiating dyspnea, chest pain, and shock in emergency department.
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Affiliation(s)
- Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Science, Federico II University Hospital, Naples, Italy
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Özdemir U, Çimen M, Güney T, Gürsel G. Validity and reliability of pocket-sized ultrasound devices in measurement of optic nerve sheath diameter in ICU patients. J Clin Monit Comput 2019; 34:597-605. [PMID: 31278545 PMCID: PMC7223003 DOI: 10.1007/s10877-019-00351-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/01/2019] [Indexed: 12/19/2022]
Abstract
The measurement of the optic nerve sheath diameter (ONSD) by ultrasonography (USG) is particularly important for intracranial pressure (ICP) monitoring when invasive measurements are not possible or are contraindicated. Standard USG (SUDs) devices can be bulky and may break down the workflow. The validity and reliability of pocket-sized USG devices (PSUDs) compared to SUDs for ONSD measurement has not been investigated, yet. We compared the reliability and validity of PSUDs with SUDs for ONSD measurement. 35 patients were included in the study. ONSD measurements with PSUDs and SUDs were performed by two clinicians as three different measurements in both sagittal and transverse axis of the eye. There was agreement between mean transverse ONSD (mtONSD), mean sagittal ONSD (msONSD), and mean ONSD(mONSD) values measured with each device according to Bland-Altman test (p = 0.166, p = 0.135, p = 0.066, respectively) with no proportional bias (p = 0.544, p = 0.868, p = 0.929, respectively). Intraclass correlation coefficients (ICC) were found to be greater than 0.7 for mtONSD, msONSD, and mONSD values measured by SUD (ICC = 0.790, ICC = 0.817, and ICC = 0.844, respectively). Similarly, for mtONSD, msONSD, and mONSD values measured by PSUD, ICC were found greater than 0.7 (ICC = 0.763, ICC = 0.814, and ICC = 0.843, respectively). There was no statistically significant difference between mtONSD and msONSD (p = 0.441 for SUD and p = 0.893 for PSUD). There was a good correlation between mtONSD and msONSD (r = 0.767 for SUD and r = 0.816 for PSUD). The total variance between three different measurements in the transverse and sagittal axis was ± 0.6 mm. PSUDs can be used with similar validity and reliability as SUDs for ONSD measurement.
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Affiliation(s)
- Uğur Özdemir
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey.
| | - Meltem Çimen
- Division of Critical Care Medicine, Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey
| | - Tuba Güney
- Division of Critical Care Medicine, Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Gül Gürsel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
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Lee JH, Lee SH, Yun SJ. Comparison of 2-point and 3-point point-of-care ultrasound techniques for deep vein thrombosis at the emergency department: A meta-analysis. Medicine (Baltimore) 2019; 98:e15791. [PMID: 31145304 PMCID: PMC6709014 DOI: 10.1097/md.0000000000015791] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND To our knowledge, so far, no studies have comprehensively examined the performance of 2-point and 3-point point-of-care compression ultrasound (POCUS) in the diagnosis of lower extremity deep vein thrombosis (DVT). The aim of this meta-analysis was to compare the performance of 2-point and 3-point POCUS techniques for the diagnosis of DVT and evaluate the false-negative rate of each POCUS method. METHODS A computerized search of the PubMed, EMBASE, and Cochrane library databases was performed to identify relevant original articles. Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the diagnostic performance of 2-point and 3-point POCUS. The pooled proportions of the false-negative rate for each POCUS method were assessed using a DerSimonian-Laird random-effects model. Meta-regression analyses were performed according to the patient and study characteristics. RESULTS Seventeen studies from 16 original articles were included (2-point, 1337 patients in 9 studies; 3-point, 1035 patients in 8 studies). Overall, 2-point POCUS had similar pooled sensitivity [0.91; 95% confidence interval (95% CI), 0.68-0.98; P = .86) and specificity (0.98; 95% CI, 0.96-0.99; P = .60) as 3-point POCUS (sensitivity, 0.90; 95% CI, 0.83-0.95 and specificity, 0.95; 95% CI, 0.83-0.99). The false-negative rates of 2-point (4.0%) and 3-point POCUS (4.1%) were almost similar. Meta-regression analysis showed that high sensitivity and specificity tended to be associated with an initial POCUS performer (including attending emergency physician > only resident) and separate POCUS training for DVT (trained > not reported), respectively. CONCLUSION Both 2-point and 3-point POCUS techniques showed excellent performance for the diagnosis of DVT. We recommend that POCUS-trained attending emergency physicians perform the initial 2-point POCUS to effectively and accurately diagnose DVT.
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Affiliation(s)
- Ju Hyung Lee
- Department of Medical Service, 8311 unit, the Republic of Korea Air Force, Chungcheongnam-do
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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