Ultrasonography and outcomes research: one small step for mankind or another drop in the bucket?

Whole body ultrasound in the operating room and intensive care unit

Whole body ultrasound can be used to improve the speed and accuracy of evaluation of an increasing number of organ systems in the critically ill. Cardiac and abdominal ultrasound can be used to identify the mechanisms and etiology of hemodynamic instability. In hypoxemia or hypercarbia, lung ultrasound can rapidly identify the etiology of the condition with an accuracy that is equivalent to that of computed tomography. For encephalopathy, ocular ultrasound and transcranial Doppler can identify elevated intracranial pressure and midline shift. Renal and bladder ultrasound can identify the mechanisms and etiology of renal failure. Ultrasound can also improve the accuracy and safety of percutaneous procedures and should be currently used routinely for central vein catheterization and percutaneous tracheostomy.

Methodological characteristics of randomized controlled trials of ultrasonography in emergency medicine

INTRODUCTION

Interest in ultrasonography in emergency medicine has increased in recent years, as reflected by a marked increase in publications on the topic. The aim of this study was to 1) describe and evaluate methodological characteristics of randomized controlled trials (RCTs) evaluating an ultrasound intervention in emergency department and 2) estimate whether the reports adequately described the intervention to allow replication.

METHODS

We searched MEDLINE via PubMed for RCTs published in 2015 assessing an ultrasound intervention, regardless of type, that were performed in an emergency department or evaluated in an emergency situation. Two researchers independently screened titles, abstracts and full texts. Data from all included studies were independently extracted. The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias of reports, and the intervention reporting was evaluated by using the Template for Intervention Description and Replication checklist.

RESULTS

We identified 11 reports. The most frequent topic was vascular access/identification (n = 4). Random sequence generation and allocation concealment were performed correctly in 55% and 27% trials. Three quarters of reports (73%) showed improper reporting or absence of participant blinding. Risk of bias due to assessor blinding was rated low for 3 RCTs (27%), risk of attrition bias low for all reports, and risk of selective outcome reporting unclear for most reports (n = 10). Only 3 reports (27%) provided an optimal description of the intervention.

CONCLUSION

The quality of these trials raises questions. In our sample, the authors did not correctly report blinding of participants and assessors or allocation concealment.

Meeting abstracts to published manuscripts: how does emergency ultrasound compare?

OBJECTIVES

Very little is known about publication rates of emergency ultrasound abstracts as peer-reviewed manuscripts in the years after their presentation at national meetings. The objectives of this study were to determine trends in publication patterns of emergency ultrasound abstracts presented at Society for Academic Emergency Medicine and American College of Emergency Physicians annual national meetings as full indexed articles in peer-reviewed journals and compare emergency ultrasound with emergency medical services (EMS) and toxicology subspecialties.

METHODS

A cross-sectional study was conducted at an academic medical center. All emergency ultrasound, EMS, and toxicology abstracts presented at both national meetings from 1999 to 2008 were entered into a database. An online PubMed/MEDLINE search was performed for full-length peer-reviewed manuscript publications corresponding to these abstracts. The proportion of abstracts presented, manuscript publication rate, time to publication, type of journal (emergency medicine versus non-emergency medicine), and journal impact factor were compared across the 3 subspecialties.

RESULTS

Over the 10-year period, 452 emergency ultrasound, 651 EMS, and 376 toxicology abstracts were presented at both meetings. The proportion of abstracts presented from 1999 to 2008 increased significantly for emergency ultrasound (1.7% versus 6.5%) compared with toxicology (3.5% versus 4.9%) and EMS (8.1% versus 5.8%; P < .01). There were no significant differences in manuscript publication rates between emergency ultrasound (22.8%), EMS (23.4%), and toxicology (20.7%). No significant differences were found in the time to publication (P = .53) and journal type (P = .2) between the 3 subspecialties.

CONCLUSIONS

The emergency ultrasound manuscript publication rate and mean time to publication compare favorably with EMS and toxicology subspecialties.