Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images

Levine, Andrea; McCurdy, Michael T.; Zubrow, Marc T.; Papali, Alfred; Mallemat, Haney; Verceles, Avelino C.

doi:10.1016/j.jcrc.2015.05.030

Cited by 47 publications

(49 citation statements)

References 24 publications

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“…One particularly valuable potential use of point‐of‐care ocular ultrasound would be in resource‐limited settings where telemedicine could be used to help identify the diagnosis where access to ophthalmology may be more limited. This has been previously found to be successful with cardiac and lung ultrasound . Further studies should assess the utility of ocular ultrasound in this area.…”

Section: Discussionmentioning

confidence: 74%

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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Background: Ocular complaints are common presentations to the emergency department (ED). Among these, retinal detachment can cause significant vision loss if not rapidly diagnosed and referred for appropriate treatment. Point-of-care ultrasound has been suggested to identify the diagnosis rapidly when the ocular examination is limited or the ophthalmology service is not readily available. However, prior studies were limited by small sample sizes, resulting in wide ranges of potential accuracy. The primary outcome for this review was to determine the test characteristics of point-of-care ocular ultrasound for the diagnosis of retinal detachment.Methods: PubMed, CINAHL, Scopus, LILACS, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and bibliographies of selected articles were assessed for all prospective and randomized controlled trials assessing the accuracy of point-of-care ultrasound for identifying retinal detachment. Data were dual extracted into a predefined worksheet and quality analysis was performed using the QUADAS-2 tool. Data were summarized and a meta-analysis was performed with planned subgroup analyses by location and provider specialty. This review was registered with PROSPERO CRD42018097288. There was no funding for this review.Results: Eleven studies (n = 844 patients) were identified. Overall, ultrasound was 94.2% (95% confidence interval [CI] = 78.4% to 98.6%) sensitive and 96.3% (95% CI = 89.2% to 98.8%) specific for the diagnosis of retinal detachment with a positive likelihood ratio of 25.2 (95% CI = 8.1 to 78.0) and a negative likelihood ratio of 0.06 (95% CI = 0.01 to 0.25). Subgroup analysis found that ultrasound was more accurate among ED patients, but was not significantly different when performed by ED or non-ED providers.Conclusions: Point-of-care ocular ultrasound is sensitive and specific for the diagnosis of retinal detachment.Future studies should determine the ideal training protocol and the influence of color Doppler and contrastenhanced ultrasound on diagnostic accuracy. O cular complaints are common emergency department (ED) presentations, accounting for approximately 3.4% of all ED visits over a 5-year period. 1 The differential diagnosis of flashes and floaters includes posterior vitreous detachment, retinal detachment, posterior uveitis, vitreous hemorrhage, oculodigital stimulation, rapid eye movements, neovascular age-related macular degeneration, migraine with aura, occipital lobe disorders, and postural hypotension. 2 While most patients will have a benign etiology, up to 10% to 26% of patients presenting with acute onset of flashes or floaters will be diagnosed with a

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Section: Discussionmentioning

confidence: 74%

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Gottlieb

Holladay

Peksa

2019

Academic Emergency Medicine

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“…32 Assuming instant availability of a trained physician at any time to "tele-mentor," this method could be both accurate and feasible. [33][34][35][36][37][38][39] However, limitations include mentor availability, a need for high-bandwidth Internet or cellular connections to maintain image quality, and technical problems such as image freezing. 39,40 Its effectiveness in clinical use has not yet been studied in rural Canada.…”

Section: Corrective Measuresmentioning

confidence: 99%

Barriers to point-of-care ultrasound use in rural emergency departments

Micks

Sue

Rogers

2016

CJEM

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Over the past few decades, point-of-care ultrasound (PoCUS) has come to play a major role in the practice of emergency medicine. Despite its numerous benefits, there has been a slow uptake of PoCUS use in rural emergency departments. Surveys conducted across Canada and the United States have identified a lack of equipment, training, funding, quality assurance, and an inability to maintain skills as major barriers to PoCUS use. Potential solutions include expanding residency training in ultrasound skills, extending funding for PoCUS training to rural physicians in practice, moving PoCUS training courses to rural sites, and creating telesonography training for rural physicians. With these barriers identified and solutions proposed, corrective measures must be taken so that the benefits of PoCUS are extended to patients in rural Canada where, arguably, it has the greatest potential for benefit when access to advanced imaging is not readily available.

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“…The feasibility of such a system should be tested in future studies. Physicians with US training can guide minimally trained nonphysicians to obtain high‐quality, clinically useful US images through 2‐way video, 39 However, it remains to be seen whether automated feedback and instructions can be used to guide a minimally trained operator without the need for an on‐call expert and image transfer to an off‐site facility.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound image transfer for off‐site interpretation has been shown to be feasible, 37 , 38 but it requires a dependable data connection and an on‐site technician who is trained to acquire images correctly. A recent pilot study demonstrated that after a brief educational session, nonphysicians in the intensive care unit could obtain clinically useful US images with real‐time tele‐intensivist guidance 39 . However, in an emergency setting, an important benefit of a FAST examination is that it can be conducted in a matter of minutes.…”

mentioning

confidence: 99%

“…A recent pilot study demonstrated that after a brief educational session, nonphysicians in the intensive care unit could obtain clinically useful US images with real-time tele-intensivist guidance. 39 However, in an emergency setting, an important benefit of a FAST examination is that it can be conducted in a matter of minutes. Telemedicine is not likely to replicate this rapid response.…”

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confidence: 99%

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Image Segmentation and Machine Learning for Detection of Abdominal Free Fluid in Focused Assessment With Sonography for Trauma Examinations

Sjögren

Leo

Feldman

et al. 2016

J of Ultrasound Medicine

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The objective of this pilot study was to test the feasibility of automating the detection of abdominal free fluid in focused assessment with sonography for trauma (FAST) examinations. Perihepatic views from 10 FAST examinations with positive results and 10 FAST examinations with negative results were used. The sensitivity and specificity compared to manual classification by trained physicians was evaluated. The sensitivity and specificity (95% confidence interval) were 100% (69.2%-100%) and 90.0% (55.5%-99.8%), respectively. These findings suggest that computerized detection of free fluid on abdominal ultrasound images may be sensitive and specific enough to aid clinicians in their interpretation of a FAST examination.

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Tele-intensivists can instruct non-physicians to acquire high-quality ultrasound images

Cited by 47 publications

References 24 publications

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Point‐of‐Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta‐Analysis

Barriers to point-of-care ultrasound use in rural emergency departments

Image Segmentation and Machine Learning for Detection of Abdominal Free Fluid in Focused Assessment With Sonography for Trauma Examinations

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