Assessing Pretest Probability in the Diagnosis of Pulmonary Thromboembolism: Is it Time to Incorporate Point-of-Care Compression Ultrasonography (POC CUS) in the Existing Scoring Systems?

2021 ◽  
Vol 60 (5) ◽  
pp. e136-e137
Author(s):  
Jyotindu Debnath ◽  
Vivek Sharma
Keyword(s):  
Pulmonary Thromboembolism ◽  
Point Of Care ◽  
Scoring Systems ◽  
Pretest Probability ◽  
Compression Ultrasonography

scholarly journals A Tool to Assess the Trustworthiness of Evidence-Based Point-of-Care Information for Health Care Professionals (CAPOCI): Design and Validation Study (Preprint)

2021 ◽  
Author(s):  
Gerlinde Lenaerts ◽  
Geertruida E Bekkering ◽  
Martine Goossens ◽  
Leen De Coninck ◽  
Nicolas Delvaux ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Delphi Study ◽  
Critical Appraisal ◽  
Point Of Care ◽  
Scoring Systems ◽  
Likert Scale ◽  
Ordinal Scale ◽  
Evidence Based ◽  
Care Information

BACKGROUND User-friendly information at the point of care for health care professionals should be well structured, rapidly accessible, comprehensive, and trustworthy. The reliability of information and the associated methodological process must be clear. There is no standard tool to evaluate the trustworthiness of such point-of-care (POC) information. OBJECTIVE We aim to develop and validate a new tool for assessment of trustworthiness of evidence-based POC resources to enhance the quality of POC resources and facilitate evidence-based practice. METHODS We designed the Critical Appraisal of Point-of-Care Information (CAPOCI) tool based on the criteria important for assessment of trustworthiness of POC information, reported in a previously published review. A group of health care professionals and methodologists (the authors of this paper) defined criteria for the CAPOCI tool in an iterative process of discussion and pilot testing until consensus was reached. In the next step, all criteria were subject to content validation with a Delphi study. We invited an international panel of 10 experts to rate their agreement with the relevance and wording of the criteria and to give feedback. Consensus was reached when 70% of the experts agreed. When no consensus was reached, we reformulated the criteria based on the experts’ comments for a next round of the Delphi study. This process was repeated until consensus was reached for each criterion. In a last step, the interrater reliability of the CAPOCI tool was calculated with a 2-tailed Kendall tau correlation coefficient to quantify the agreement between 2 users who piloted the CAPOCI tool on 5 POC resources. Two scoring systems were tested: a 3-point ordinal scale and a 7-point Likert scale. RESULTS After validation, the CAPOCI tool was designed with 11 criteria that focused on methodological quality and author-related information. The criteria assess authorship, literature search, use of preappraised evidence, critical appraisal of evidence, expert opinions, peer review, timeliness and updating, conflict of interest, and commercial support. Interrater agreement showed substantial agreement between 2 users for scoring with the 3-point ordinal scale (τ=.621, <i>P</i>&lt;.01) and scoring with the 7-point Likert scale (τ=.677, <i>P</i>&lt;.01). CONCLUSIONS The CAPOCI tool may support validation teams in the assessment of trustworthiness of POC resources. It may also provide guidance for producers of POC resources.

scholarly journals Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis

2020 ◽  
Vol 4 (20) ◽  
pp. 5002-5010
Author(s):  
Synne G. Fronas ◽  
Camilla T. Jørgensen ◽  
Anders E. A. Dahm ◽  
Hilde S. Wik ◽  
Jostein Gleditsch ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Pretest Probability ◽  
Vein Thrombosis ◽  
Venous Thromboembolic ◽  
Deep Vein ◽  
D Dimer ◽  
Rule Out ◽  
Compression Ultrasonography ◽  
High Pretest Probability

Abstract Guidelines for the diagnostic workup of deep vein thrombosis (DVT) recommend assessing the clinical pretest probability before proceeding to D-dimer testing and/or compression ultrasonography (CUS) if the patient has high pretest probability or positive D-dimer. Referring only patients with positive D-dimer for whole-leg CUS irrespective of pretest probability may simplify the workup of DVT. In this prospective management outcome study, we assessed the safety of such a strategy. We included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected DVT between February 2015 and November 2018. STA-Liatest D-Di Plus D-dimer was analyzed for all patients, and only patients with levels ≥0.5 µg/mL were referred for CUS. All patients with negative D-dimer or negative CUS were followed for 3 months to assess the venous thromboembolic rate. One thousand three hundred ninety-seven patients were included. Median age was 64 years (interquartile range, 52-73 years), and 770 patients (55%) were female. D-dimer was negative in 415 patients (29.7%) and positive in 982 patients (70.3%). DVT was diagnosed in 277 patients (19.8%). Six patients in whom DVT was ruled out at baseline were diagnosed with DVT within 3 months of follow-up for a thromboembolic rate of 0.5% (95% confidence interval, 0.2-1.2). A simple diagnostic approach with initial stand-alone D-dimer followed by a single whole-leg CUS in patients with positive D-dimer safely ruled out DVT. We consider this strategy to be a valuable alternative to the conventional workup of DVT in outpatients. This trial was registered at www.clinicaltrials.gov as #NCT02486445.

Systematic Review: Clinical Utility of Gastrointestinal Ultrasound in the Diagnosis, Assessment and Management of Patients With Ulcerative Colitis

2019 ◽  
Vol 14 (4) ◽  
pp. 465-479 ◽  
Author(s):  
Rebecca L Smith ◽  
Kirstin M Taylor ◽  
Antony B Friedman ◽  
Robert N Gibson ◽  
Peter R Gibson
Keyword(s):  
Ulcerative Colitis ◽  
Point Of Care ◽  
Scoring Systems ◽  
Image Resolution ◽  
Current Evidence ◽  
Clinical Value ◽  
Disease Extent ◽  
Normal Limits ◽  
Gastrointestinal Ultrasound ◽  
Limited Application

Abstract Background and Aims Gastrointestinal ultrasound is useful in the assessment of patients with Crohn’s disease, but its application in ulcerative colitis [UC] is less well established. Here we systematically review the role of gastrointestinal ultrasound in patients with UC. Methods Searches of the PUBMED and EMBASE databases were performed with the following search strategy: [ultrasound OR sonography] AND [intestinal OR bowel] AND [ulcerative colitis OR inflammatory bowel disease]. The final search was performed in August 2019. Results Of 6769 studies identified in the search with a further two studies found from other sources, 50 studies met the inclusion criteria. Increased bowel wall thickness and detection of increased blood flow by colour Doppler were the most often applied criteria for defining disease activity and distribution. When compared with other reference investigations, gastrointestinal ultrasound accurately determined disease extent, severity and response to medical therapy. While further information can be obtained from haemodynamic measurements of the abdominal vessels and contrast-enhanced ultrasound, their clinical value was uncertain. Likewise, hydrocolonic sonography has few advantages over standard gastrointestinal ultrasound examination. Of several scoring systems proposed, there is disparity between the measures and a general lack of validation. There has been limited application of gastrointestinal ultrasound in acute severe ulcerative colitis with toxic megacolon, and, while performing well in children, normal limits differ from those in adults. Conclusion Current evidence indicates that gastrointestinal ultrasound has utility in the non-invasive assessment of patients with UC. Continued advances in technology with better image resolution, validation of scoring systems and application at the point of care by gastroenterologists are likely to contribute to increased use of gastrointestinal ultrasound in routine clinical practice.

scholarly journals Point-of-care ultrasonography (POCUS) in hemophilia A: a commentary on current status and its potential role for improving prophylaxis management in severe hemophilia A

2017 ◽  
Vol 8 (4) ◽  
pp. 153-156 ◽  
Author(s):  
Suchitra S. Acharya ◽  
Brittny Rule ◽  
Omar McMillan ◽  
Thomas J. Humphries
Keyword(s):  
Hemophilia A ◽  
Point Of Care ◽  
Scoring Systems ◽  
Current Status ◽  
Recurrent Bleeding ◽  
Severe Hemophilia ◽  
Transitional Age ◽  
Point Of Care Ultrasonography ◽  
User Friendly

In patients with severe hemophilia A, recurrent bleeding into joints results in increased morbidity and reduced quality of life. Prophylaxis using replacement factor products, especially when initiated early, has established benefits in terms of reducing joint bleeds and preserving joint function. Poor adherence to prophylactic regimens is a common cause for breakthrough bleeds and resultant arthropathy. Improving prophylaxis management, especially in the transitional age group, is a challenge. Here, we discuss the current status of ultrasonography (US) in hemophilia A, challenges in its wider implementation, and the potential for use of point-of-care US (POCUS) as an adjunct in the routine management of patients with hemophilia following prophylaxis regimens. Using POCUS, in which US is performed by trained hematologists and nonphysician operators (rather than comprehensive US performed by imaging specialists), specific clinical questions can be addressed in a time-efficient, user-friendly manner to promote adherence to prophylaxis and guide or modify treatment approaches. This review also discusses barriers to acceptance of POCUS as a part of routine management of patients with hemophilia, including questions related to its diagnostic accuracy, dependence on trained operators, agreement on appropriate scoring systems, and potential usefulness in patient management.

scholarly journals Pre-clinical medical student cardiac point-of-care ultrasound curriculum based on the American Society of Echocardiography recommendations: a pilot and feasibility study

2020 ◽  
Author(s):  
Satoshi Jujo ◽  
Jannet J Lee-Jayaram ◽  
Brandan I Sakka ◽  
Atsushi Nakahira ◽  
Akihisa Kataoka ◽  
...  
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Pilot Study ◽  
Point Of Care ◽  
Scoring Systems ◽  
Recruitment Rate ◽  
Point Of Care Ultrasound ◽  
Hands On ◽  
Test Scoring ◽  
American Society

Abstract Background Cardiac point-of-care ultrasound (POCUS) training has been integrated into medical school curricula. However, there is no standardized cardiac POCUS training method for medical students. To address this issue, the American Society of Echocardiography (ASE) proposed a framework for medical student cardiac POCUS training. The objective of this pilot study was to develop a medical student cardiac POCUS curriculum with test scoring systems and test the curriculum feasibility for a future definitive study.Methods Based on the ASE-recommended framework, we developed a cardiac POCUS curriculum consisting of a pre-training online module and hands-on training with a hand-held ultrasound (Butterfly iQ). The curriculum learning effects were assessed with a 10-point maximum skill test and a 40-point maximum knowledge test at pre-, immediate post-, and 8-week post-training. To determine the curriculum feasibility, we planned to recruit 6 pre-clinical medical students. We semi-quantitatively evaluated the curriculum feasibility in terms of recruitment rate, follow-up rate 8 weeks after training, instructional design of the curriculum, the effect size (ES) of the test score improvements, and participant satisfaction. Discriminatory ability of the test scoring systems were assessed by comparing the scores of the medical students, medical interns, and experts.Results Six pre-clinical medical students participated in the curriculum. The recruitment rate was 100% (6/6 students) and the follow-up rate 8 weeks after training was 100% (6/6). ESs of skill and knowledge test score differences between pre- and immediate post-, and between pre- and 8-week post-training were large. The students reported high satisfaction with the curriculum. The test scoring systems demonstrated excellent discriminatory ability between the 3 different performance levels.Conclusions This pilot study confirmed the curriculum design as feasible with instructional design modifications including the hands-on training group size, content of the cardiac POCUS lecture, hands-on teaching instructions, and hand-held ultrasound usage. Based on the pilot study findings, we plan to conduct the definitive study with the primary outcome of long-term skill retention 8 weeks after initial training. The definitive study has been registered in ClinicalTrials.gov (Identifier: NCT04083924).

Determining pretest probability of DVT: Clinical intuition vs. validated scoring systems

2003 ◽  
Vol 21 (2) ◽  
pp. 161-162 ◽  
Author(s):  
Howard A. Smithline ◽  
Timothy J. Mader ◽  
Fahad M.N. Ali ◽  
Michael N. Cocchi
Keyword(s):  
Scoring Systems ◽  
Pretest Probability ◽  
Clinical Intuition

scholarly journals The diagnostic accuracy of multi-organ point-of-care ultrasonography for life-threatening conditions: The case of cancer patients who visit the emergency department: retrospective observational study

2021 ◽  
Author(s):  
Yun Ang Choi ◽  
Min Sung Lee ◽  
Tae Kwon Kim ◽  
Jae Yun Jung ◽  
Ki Hong Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Positive Predictive Value ◽  
Cancer Patients ◽  
Predictive Value ◽  
Pulmonary Thromboembolism ◽  
Point Of Care ◽  
Threatening Condition ◽  
Life Threatening ◽  
Point Of Care Ultrasonography

Abstract Background The number of cancer patients visiting the emergency department (ED) is increasing globally, and this has highlighted the importance of diagnosing and coping with related life-threatening complications early. There may be efficacy in employing multi-organ point-of-care ultrasonography (M-PoCUS) for this purpose; however, there has been no study on the usefulness of this diagnostic tool for cancer patients only. The aim of this study was to evaluate the diagnostic accuracy of M-PoCUS for a life-threatening condition in cancer patients who visited the ED.Methods We conducted a retrospective observational study in one tertiary university hospital ED in Seoul, Republic of Korea. We selected three emergency medicine specialists to perform a protocolized M-PoCUS evaluation of cancer patients according to the requests of emergency physicians since the SARS-CoV-2 pandemic began. We enrolled 94 cancer patients in the study. The M-PoCUS diagnosis was then compared with an audit diagnosis. The primary outcomes measured were the sensitivity, specificity, positive predictive value, and negative predictive value of M-PoCUS in the above-described diagnosis.Results The M-PoCUS showed a sensitivity of 83% (95% CI, 61-95), specificity of 96% (95% CI, 88-99), positive predictive value of 86% (95% CI, 65-97), and negative predictive value of 94% (95% CI, 85-97). M-PoCUS produced 4 false negative (4.3%) pulmonary thromboembolism diagnoses and 3 false positive (3.2%) pleural effusion diagnoses. Conclusions M-PoCUS was useful in ruling out a life-threatening condition among the cancer patients. However, pulmonary thromboembolism was hard to distinguish using M-PoCUS due to pre-existing diseases scattered in cancer patients’ thorax.

scholarly journals The Diagnosis of Acute Pulmonary Embolism

2014 ◽  
Vol 2 (8) ◽  
pp. 21 ◽  
Author(s):  
Ebtesam Islam ◽  
Victor J. Test
Keyword(s):  
Pulmonary Embolism ◽  
Comprehensive Evaluation ◽  
Pulmonary Thromboembolism ◽  
Imaging Techniques ◽  
Scoring Systems ◽  
Diagnostic Strategy ◽  
Multiple Imaging ◽  
Wells Score ◽  
Lung Scanning ◽  
Rule Out

This paper reviews the most current literature on the diagnosis of pulmonary thromboembolism.  The epidemiology and symptomology of this disorder, including common symptoms such as fever, chest pain, dyspnea, edema, and syncope, are reviewed.  The utility of basic and easily available testing, such as electrocardiography and chest radiography, is evaluated. The literature on determining the pretest probability of venous thromboembolism with scoring systems, such as the Wells Score, the Geneva Scoring System, and the Pulmonary Embolism Rule Out Criteria, is appraised.  As the evaluation of pulmonary embolism has evolved, multiple imaging techniques has been developed and studied.  Ultrasonography, computed tomography with angiography, magnetic resonance angiography, ventilation perfusion lung scanning, and SPECT ventilation-perfusion lung imaging are discussed.  In conclusion, the diagnosis of pulmonary embolism remains complicated.  Clinical suspicion and stratification should guide a diagnostic strategy for the comprehensive evaluation and diagnosis of patients with this disorder.

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