Use of Limited Transthoracic Echocardiography in Patients With Traumatic Cardiac Arrest Decreases the Rate of Nontherapeutic Thoracotomy and Hospital Costs

Ferrada, Paula; Wolfe, Luke; Whelan, James; Vanguri, Poornima; Malhotra, Ajai K.; Goldberg, Solomon C.; Duane, Therèse M.; Aboutanos, Michel B.

doi:10.7863/ultra.33.10.1829

Cited by 32 publications

(17 citation statements)

References 26 publications

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“…Furthermore, POCLUS has been shown to decrease length of stay in the ED in children with concern for pneumonia . It is also noted that the use of POCLUS is associated with lower financial costs by reducing the use of more invasive and expensive diagnostic tests, shortened ED stay, and less complications associated with invasive procedures (e.g., thoracentesis) …”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Tsou

Chen

Wang

et al. 2019

Academic Emergency Medicine

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Background: Childhood pneumonia is a leading cause of mortality worldwide. Growing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic alternative to chest x-ray for childhood pneumonia. However, it is unclear whether sonographer experience affects the diagnostic accuracy of LUS. We summarize the diagnostic accuracy of LUS for pneumonia and compare the performance between novice and advanced sonographers with a systematic review and meta-analysis. Methods:We searched PubMed and EMBASE from inception to February 2018 for eligible studies that evaluated the utility of LUS in children suspected of having pneumonia against the reference standard of either imaging results alone or a combination of clinical, laboratory, and imaging results. We reported the study using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies. We used QUADAS-2 to appraise the included studies' methodologic quality. We employed a random-effect bivariate model and a hierarchical summary receiver operating characteristic curve to evaluate LUS's performance characteristics. We conducted subgroup analyses and meta-regression based on level of sonographer training to summarize and compare LUS's diagnostic accuracy for pneumonia between novice (training ≤ 7 days) and advanced sonographers.Results: Twenty-five studies (n = 3,353) were included in the meta-analysis. For diagnosing pneumonia, LUS demonstrated an overall sensitivity of 0.94 (95% confidence interval [CI] = 0.89 to 0.97), specificity of 0.92 (95% CI = 0.78 to 0.98), positive likelihood ratio of 12.40 (95% CI = 4.00 to 38.10), and negative likelihood ratio of 0.07 (95% CI = 0.04 to 0.12), with an area under ROC curve of 0.97 (95% CI = 0.95 to 0.98). Meta-regression revealed a significant difference in the diagnostic accuracy for pneumonia for LUS between novice and advanced sonographers (p < 0.01).Conclusion: LUS can accurately diagnose pneumonia in children. However, this test demonstrates operatordependent variability, with more experienced sonographers having higher diagnostic accuracy. Further work on evidence-based educational methods to train novice sonographers in LUS is required.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Tsou

Chen

Wang

et al. 2019

Academic Emergency Medicine

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“…Eine Perikardpunktion mit einer Nadel ist, egal ob mit oder ohne Ultraschallsteuerung, bei einer Perikardtamponade nicht Erfolg versprechend, weil das Blut im Perikardraum üblicher-weise schon geronnen ist [194,195] [173,196]. Hämoperitoneum, Hämato-oder Pneumothorax und die Perikardtamponade kann man so auch prä-klinisch innerhalb von wenigen Minuten diagnostizieren [197].…”

Section: "Elapsed Time" (Zeitverzögerung)unclassified

Kreislaufstillstand in besonderen Situationen

Truhlář

Deakin

Soar

et al. 2015

Notfall Rettungsmed

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“…Incorporation of US at all CA may improve cost effectiveness and efficiency of hospital resource distribution. Rapid TTE improved the use of health care resources in patients with CA secondary to trauma, where patients who did not received US had a significantly higher mean cost of care, with an average of approximately $1100 less spent on the US examined group [81]. The prognostic value of US in CA carries an additional resource utilization benefit when considering effects such as ending futile resuscitative efforts earlier and redirecting valuable physician time, hospital personnel resources, as well as medication and equipment costs.…”

Section: Discussionmentioning

confidence: 99%

Focused Sonography in Cardiac Arrest

Delaney¹,

Flora²,

Ahmad³

2017

Resuscitation Aspects

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Cardiac arrest (CA) is a high mortality event where the ability for clinicians to diagnose etiology and assess for intervention has a direct impact on patient outcomes. Bedside ultrasound (US) has emerged in current literature as a clinical tool to aid clinicians in CA resuscitation, though it remains underutilized. Reversible etiologies that can be efficiently diagnosed with US include tension pneumothorax, hypovolemia, pulmonary embolus with acute cor pulmonale, and cardiac tamponade. Other US findings may provide evidence in regard to prognosis. In this review, we present major applications of US in CA, compare existing protocols, and propose future research needs.

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Use of Limited Transthoracic Echocardiography in Patients With Traumatic Cardiac Arrest Decreases the Rate of Nontherapeutic Thoracotomy and Hospital Costs

Abstract: In this study, image-guided resuscitation with LTTE decreased the time in the trauma bay and avoided nontherapeutic thoracotomy in nonsurviving trauma patients. Limited TTE could improve the use of health care resources in patients with traumatic cardiac arrest.

Cited by 32 publications

References 26 publications

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Diagnostic Accuracy of Lung Ultrasound Performed by Novice Versus Advanced Sonographers for Pneumonia in Children: A Systematic Review and Meta‐analysis

Kreislaufstillstand in besonderen Situationen

Focused Sonography in Cardiac Arrest

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