Accuracy of point-of-care ultrasound by pediatric emergency physicians for testicular torsion

AbstractBackgroundAdult and pediatric emergency physicians have been using point-of-care ultrasound (POCUS) for many years. It is a fast, usually painless, noninvasive diagnostic tool that does not expose the patient to radiation. Information about its current implementation in pediatric emergency medicine (PEM) fellowship programs in Canada is lacking.ObjectiveThe main goal of our study was to investigate current integration and future direction of POCUS training in Canadian PEM programs.MethodsThe study consisted of two surveys designed for fellows and program directors of all Canadian PEM fellowship programs. The major aspects of the survey were 1) to describe current training in POCUS in fellowship programs, 2) to compare the kind of training that programs offer with what fellows actually receive, and 3) a needs assessment by fellows and program directors for future POCUS training programs. Surveys were sent to program directors and passed on to their fellows.ResultsNinety percent of fellowship program directors as well as 70% (42/60) of fellows responded to the survey. A formal POCUS curriculum exists in five of the nine PEM programs included in this study. Three programs offer specific pediatric POCUS training. The main application is the FAST (focused assessment with sonography for trauma) exam.ConclusionThere is a wide variation in POCUS content and delivery across PEM fellowship programs, as well as differences in perceptions of current training and of needs by fellows and program directors. However, given that both groups feel POCUS is very important and essential for PEM training, the opportunity exists to develop a standardized curriculum across Canada.

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Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

10.21203/rs.2.17852/v3 ◽

2020 ◽

Author(s):

Jeong-Yong Lee ◽

Jung Heon Kim ◽

Seung Jun Choi ◽

Jong Seung Lee ◽

Jeong-Min Ryu

Keyword(s):

Abdominal Pain ◽

Early Stage ◽

Point Of Care ◽

Abdominal Mass ◽

Pediatric Emergency ◽

Symptom Duration ◽

Point Of Care Ultrasound ◽

Bloody Stool ◽

Emergency Physicians ◽

Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

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Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

10.21203/rs.2.17852/v1 ◽

2019 ◽

Author(s):

Jeong-Yong Lee ◽

Jung Heon Kim ◽

Seung Jun Choi ◽

Jong Seung Lee ◽

Jeong-Min Ryu

Keyword(s):

Abdominal Pain ◽

Early Stage ◽

Point Of Care ◽

Abdominal Mass ◽

Pediatric Emergency ◽

Symptom Duration ◽

Point Of Care Ultrasound ◽

Bloody Stool ◽

Emergency Physicians ◽

Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children who underwent POCUS for the detection of intussusception in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to lower standards wherein POCUS was performed in the presence of any one of the following symptoms: intermittent abdominal pain, bloody stool, ≥2 causes of nonspecific abdominal pain, abdominal mass, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain (P < 0.001), but less vomiting (P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to lower standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

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Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

10.21203/rs.2.17852/v2 ◽

2020 ◽

Author(s):

Jeong-Yong Lee ◽

Jung Heon Kim ◽

Seung Jun Choi ◽

Jong Seung Lee ◽

Jeong-Min Ryu

Keyword(s):

Abdominal Pain ◽

Early Stage ◽

Point Of Care ◽

Abdominal Mass ◽

Pediatric Emergency ◽

Symptom Duration ◽

Point Of Care Ultrasound ◽

Bloody Stool ◽

Emergency Physicians ◽

Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

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Point-Of-Care Ultrasound in Pediatric Emergency Medicine: What Do Fellows Need to Know?

Clinical Pediatric Emergency Medicine ◽

10.1016/j.cpem.2015.10.002 ◽

2015 ◽

Vol 16 (4) ◽

pp. 269-273

Author(s):

Beth M. D’Amico

Keyword(s):

Emergency Medicine ◽

Point Of Care ◽

Pediatric Emergency ◽

Point Of Care Ultrasound ◽

Pediatric Emergency Medicine

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The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

Emergency Medicine International ◽

10.1155/2018/3684081 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 9

Author(s):

A. Pourmand ◽

U. Dimbil ◽

A. Drake ◽

H. Shokoohi

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Imaging Modality ◽

Point Of Care ◽

High Sensitivity ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Short Term ◽

Intestinal Peristalsis

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops > 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO.

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Do emergency physicians rely on point-of-care ultrasound for clinical decision making without additional confirmatory testing?

Journal of Clinical Ultrasound ◽

10.1002/jcu.22604 ◽

2018 ◽

Vol 46 (7) ◽

pp. 437-441 ◽

Cited By ~ 3

Author(s):

Mohamad Moussa ◽

Julie M. Stausmire

Keyword(s):

Decision Making ◽

Clinical Decision Making ◽

Point Of Care ◽

Clinical Decision ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Confirmatory Testing

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P005: Regional anesthesia in Canadian emergency departments: Emergency physician practices and impressions

CJEM ◽

10.1017/cem.2020.213 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S66-S66

Author(s):

D. Wiercigroch ◽

S. Friedman ◽

D. Porplycia ◽

M. Ben-Yakov

Keyword(s):

Regional Anesthesia ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Physician Practices ◽

Canadian Association ◽

Modifiable Factors ◽

Barriers To Use

Introduction: The use of regional anesthesia (RA) by emergency physicians (EPs) is expanding in frequency and range of application as expertise in point-of-care ultrasound (POCUS) grows, but widespread use remains limited. We sought to characterize the use of RA by Canadian EPs, including practices, perspectives and barriers to use in the ED. Methods: A cross-sectional survey of Canadian EPs was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical responses. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables. Results: The survey was completed by 149/1144 staff EPs, with a response rate of 13%. EPs used RA a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of EPs, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). EPs agreed that RA is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had POCUS available, however less than half (49.0%) felt comfortable using it for RA. EPs indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use. Conclusion: Canadian EPs engage in limited use of RA but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake of RA in the ED.

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