Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases

Farsi, Davood; Hajsadeghi, Skokoufeh; Hajighanbari, Mohammad Javad; Mofìdi, Mani; Hafezimoghadam, Peyman; Rezai, Mahdi; Mahshidfar, Babak; Abiri, Samaneh; Abbasi, Saeed

doi:10.1007/s40477-017-0246-5

Cited by 45 publications

(64 citation statements)

References 17 publications

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“… 8 Previous studies have demonstrated that POCUS performed by emergency medicine residents is comparable to echocardiography performed by cardiologists. 9 Even in the hands of a non-POCUS focused EP, it was evident upon first glance that the heart in this case was abnormal. We feel that any EP with the most basic emergency echocardiography education would have identified the “abnormal” large mass/thrombus visualized in this case.…”

Section: Discussionmentioning

confidence: 74%

Point-of-care Echocardiogram as the Key to Rapid Diagnosis of a Unique Presentation of Dyspnea: A Case Report

Moore

Dilcher

Minardi

et al. 2020

Clinical Practice and Cases in Emergency Medicine

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Introduction: Dyspnea is commonly evaluated in the emergency department (ED).The differential diagnosis is broad. Due to the large volume of dyspneic patients evaluated, emergency physicians (EP) will encounter uncommon diagnoses. Early, liberal application of point-of-care ultrasound (POCUS) may decrease diagnostic error and improve care for these patients. Case Report: We report a 48-year-old male presenting to the ED with cough and progressively worsening dyspnea for 11 months after multiple healthcare visits. Using POCUS, the EP was immediately able to diagnose a severe dilated cardiomyopathy (DCM) with left ventricular thrombus. Conclusion: Given that non-ischemic DCM is one of the most common etiologies of heart failure, often presenting with respiratory symptoms, POCUS is key to rapid diagnosis and, along with modalities such as electrocardiography and chest radiograph, should be standard practice in the workup of dyspnea, regardless of age or comorbidities.

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Section: Discussionmentioning

confidence: 74%

Point-of-care Echocardiogram as the Key to Rapid Diagnosis of a Unique Presentation of Dyspnea: A Case Report

Moore

Dilcher

Minardi

et al. 2020

Clinical Practice and Cases in Emergency Medicine

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“…or ventriculogram88 (75–96)92 (75–99)11.5 (3.1–43.7)0.13 (0.05–0.29)Speckle trackingReardon et al [53]EP2018USANR751652Cardiologist echo. or final diagnosis ACS29 (17–46)88 (72–96)2.4 a 0.81 a Pericardial effusionMandavia et al [54]EP2001USA5 h.51520NRCardiologist echo.96.0 (90.4–98.9)98.0 (95.8 to 99.1)48.0 a 0.0408 a Farsi et al [43]EP2017Iran10 h.2051061Cardiologist echo.86 (63–96)96 (91–98)20 (10–40)0.15 (0.05–0.40)Shah et al [42]EP2016Haiti30 h.117836Cardiologist echo.88.9 (50.7–99.4)99.1 (94.2–100)98.8 a 0.112 a Bustam et al [39]EP2014Malaysia3 h.1005NRCardiologist echo.60 (15 a –95 a )100 (96 a –100 a )∞ a 0.40 a MA, meta-analysis (shown in italics with number of studies in brackets); Op., operators; Train., time spent in didactic intervention; n , size of population; Prev., prevalence; Age, medi...…”

Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

109

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Background: Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services.Methods: Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. Results:On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/ thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. Conclusion:Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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“…However, they require more expertise and several technical pitfalls and standardization issues remain. With the widespread utilization of portable and handheld echocardiography in emergency departments and intensive care units to evaluate patient hemodynamics, LV wall motion assessment is an easier method to assess LV systolic function and is generalizable to a wider range of physicians with various level of training, expertise and echocardiographic equipment ( 24 , 25 , 26 ). We have shown herein that a simple segmental score (EF 15-40-65) applied to each of the 16 segments results in a robust estimation of LVEF by echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Assessment of LVEF using a new 16-segment wall motion score in echocardiography

et al. 2018

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BackgroundSimpson biplane method and 3D by transthoracic echocardiography (TTE), radionuclide angiography (RNA) and cardiac magnetic resonance imaging (CMR) are the most accepted techniques for left ventricular ejection fraction (LVEF) assessment. Wall motion score index (WMSI) by TTE is an accepted complement. However, the conversion from WMSI to LVEF is obtained through a regression equation, which may limit its use. In this retrospective study, we aimed to validate a new method to derive LVEF from the wall motion score in 95 patients.MethodsThe new score consisted of attributing a segmental EF to each LV segment based on the wall motion score and averaging all 16 segmental EF into a global LVEF. This segmental EF score was calculated on TTE in 95 patients, and RNA was used as the reference LVEF method. LVEF using the new segmental EF 15-40-65 score on TTE was compared to the reference methods using linear regression and Bland–Altman analyses.ResultsThe median LVEF was 45% (interquartile range 32–53%; range from 15 to 65%). Our new segmental EF 15-40-65 score derived on TTE correlated strongly with RNA-LVEF (r = 0.97). Overall, the new score resulted in good agreement of LVEF compared to RNA (mean bias 0.61%). The standard deviations (s.d.s) of the distributions of inter-method difference for the comparison of the new score with RNA were 6.2%, indicating good precision.ConclusionLVEF assessment using segmental EF derived from the wall motion score applied to each of the 16 LV segments has excellent correlation and agreement with a reference method.

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Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases

Abstract: FOCUS performed by emergency medicine residents is comparable to echocardiography performed by cardiologists. Therefore, it could be a reliable tool and screening test for initial testing of patients suspected of cardiac abnormalities.

Cited by 45 publications

References 17 publications

Point-of-care Echocardiogram as the Key to Rapid Diagnosis of a Unique Presentation of Dyspnea: A Case Report

Point-of-care Echocardiogram as the Key to Rapid Diagnosis of a Unique Presentation of Dyspnea: A Case Report

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Assessment of LVEF using a new 16-segment wall motion score in echocardiography

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