An overview of emergency ultrasound in the United States

Michalke, J.

doi:10.5847/wjem.j.issn.1920-8642.2012.02.001

Cited by 19 publications

(9 citation statements)

References 32 publications

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“…This approach can be considered anachronistic by now, because it dates back to an era when thoracic US was not as widespread and standardized as it is now [50].…”

Section: Discussionmentioning

confidence: 99%

Extended-FAST plus MDCT in pneumothorax diagnosis of major trauma: time to revisit ATLS imaging approach?

et al. 2019

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Background and objective Pneumothorax (PNX) detection is of the utmost clinical relevance because it may quickly progress to cause hemodynamic instability as a consequence of invasive ventilation. Radiography is characterized by a low sensitivity to detect this disease; in recent years, chest ultrasound (US) has gained increased visibility in the diagnosis of acute respiratory emergencies including PNX. The aim of this retrospective study was to evaluate the clinical impact of extended focused assessment with sonography in trauma (E-FAST) during the past 6 years of experience with this technique in our Level I trauma center. Methods Between January 2013 and December 2018, we performed a retrospective case-series study including 3320 consecutive patients admitted to the emergency department of our hospital because of major trauma. Extended-US was always performed and reported immediately after FAST during primary survey and before multidetector computed tomography (MDCT) scans. The presence of PNX was determined using the well-known accepted US criteria. US findings were compared with computed tomography (CT) findings, the reference standard for PNX detection. Results Of the 6640 lungs observed with E-FAST, there were 1244 PNX cases, while 1328 PNX cases were detected either on the basis of MDCT or on the basis of the presence of air flush during the thoracic decompression in the emergency room. Among the 84 false negatives, 12 patients had subcutaneous emphysema, 38 had a body mass index higher than 27, 6 had a thoracic wall hematoma, and 4 had chest penetrating trauma. There were 10 false positives in the diagnosis of PNX at US examination, with mild extension and not clinically significant. The overall sensitivity of E-FAST for PNX detection was 93.6% (1244/1328), the specificity of E-FAST was 99.8% (5312/5322), the negative predictive value (NPV) was 98.4% (5312/5396), and the positive predictive value (PPV) was 99.2% (1328/1338). Conclusion Our results demonstrate that bedside thoracic US is characterized by a very good accuracy in the diagnostic work-up of major trauma patients, even in difficult conditions, allowing rapid diagnosis of PNX. Advances in knowledge The novelty of this research lies in the possibility of diagnosing potential life-threatening conditions in a very short time by means of US, thus proposing a revision of the Advanced Trauma Life Support (ATLS) guidelines in order to incorporate it in the work-up of high-energy injured patients.

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“…This approach can be considered anachronistic by now, because it dates back to an era when thoracic US was not as widespread and standardized as it is now [50].…”

Section: Discussionmentioning

confidence: 99%

Extended-FAST plus MDCT in pneumothorax diagnosis of major trauma: time to revisit ATLS imaging approach?

et al. 2019

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“…It has shown to have superior diagnostic value in detection of thoracic traumatic injuries. However, diagnostic accuracy of ultrasonography is highly dependent on the skills of the operator and is usually not reliable in detection of injuries without bleeding or free fluid (6) .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Chest Ultrasound versus Plain Chest X-ray in Acute Assessment of Traumatic Hemothorax

Attia¹,

Gwely²,

Ibrahim³

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Trauma is the leading cause of death in young adults, as well as a significant cause of morbidity and mortality in people of all ages. Ultrasonography (US) is a good first imaging modality because it is fast, repeatable, and noninvasive. It can also be achieved at the same time as other resuscitative steps, providing critical information without the time delay caused by radiograph or CT scan execution and interpretation. Objective: To compare the diagnostic accuracy of chest ultrasound with plain chest X-ray in acute assessment of traumatic hemothorax at Emergency Hospital, Mansoura University. Patients and methods: This was a cross-sectional study included a total of 109 patients with polytrauma and conducted at Emergency Medicine Department, Mansoura University from November 2019 to October 2020. Emergency Hospital, Mansoura University is a level one trauma center with about 250,000 visit and 25,000 trauma cases per year. Results: The X-ray findings in the cases included in the study where fracture ribs was detected in 76 cases (69.7%), lung contusions in 28 cases (25.7%), obliteration of costophrenic angles in 17 cases (15.6%) and tension pneumothorax in 38 cases (34.9%). US showed 86.2% sensitivity, 100% specificity, PPV 100%, NPV 95.2% and 96.3% accuracy. X-ray showed 58.6% sensitivity, 100% specificity, PPV 100%, NPV 86.9% and 89% accuracy. Conclusion: Ultrasound has significant value in initial assessment of life-threatening conditions of trauma with acceptable sensitivity and high specificity.

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“…12 In the last two decades, ultrasound performed and interpreted by physicians at the bedside has seen widespread adoption, including in the United States. 13 These exams are often performed on critically ill patients in whom diagnostic decisions and the response to therapies provided can be assessed rapidly by ultrasound. This type of ultrasound is referred to as POCUS.…”

Section: History Of Ultrasoundmentioning

confidence: 99%

Prehospital point-of-care ultrasound: A transformative technology

2020

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Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.

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An overview of emergency ultrasound in the United States

Cited by 19 publications

References 32 publications

Extended-FAST plus MDCT in pneumothorax diagnosis of major trauma: time to revisit ATLS imaging approach?

Extended-FAST plus MDCT in pneumothorax diagnosis of major trauma: time to revisit ATLS imaging approach?

Diagnostic Accuracy of Chest Ultrasound versus Plain Chest X-ray in Acute Assessment of Traumatic Hemothorax

Prehospital point-of-care ultrasound: A transformative technology

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