scholarly journals Point-of-Care Ultrasound (POCUS) Predicts Clinical Outcomes in Patients with COVID-19.

2021 ◽  
Author(s):  
Andre Kumar ◽  
Yingjie Weng ◽  
Sally Graglia ◽  
Thomas Lew ◽  
Kavita Gandhi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Point Of Care ◽  
Supplemental Oxygen ◽  
Adverse Outcomes ◽  
Normal Lung ◽  
Point Of Care Ultrasound ◽  
Icu Admission ◽  
Medical Centers ◽  
Emergency Department Triage ◽  
B Lines

Introduction: Point-of-care ultrasound (POCUS) may detect the cardiopulmonary manifestations of COVID-19 and expediently predict patient outcomes. Methods: We conducted a prospective cohort study at four medical centers from 3/2020-1/2021 to evaluate POCUS findings and clinical outcomes with COVID-19. Our inclusion criteria included adult patients hospitalized for COVID-19 who received cardiac or lung POCUS with a 12-zone protocol. Images were interpreted by two reviewers blinded to clinical outcomes. Our primary outcome was ICU admission incidence. Secondary outcomes included intubation and supplemental oxygen usage. Results: N=160 patients (N=201 scans) were included. Scans were collected a median 23 hours (IQR:7-80) from emergency department triage. Triage POCUS findings associated with ICU admission included B-lines (OR 4.41 [95% CI:1.71-14.30]; p<0.01) or consolidation (OR 2.49 [95% CI:1.35-4.86]; p<0.01). B-lines were associated with intubation (OR 3.10 [95% CI:1.15-10.27]; p=0.02) and supplemental oxygen usage (OR 3.74 [95% CI:1.63-8.63; p<0.01). Consolidations present on triage were associated with the need for oxygen at discharge (OR 2.16 [95% CI: 1.01-4.70]; p=0.047). A normal lung triage scan was protective for ICU admission (OR 0.28 [95% CI:0.09-0.75; p<0.01) or need for supplemental oxygen during the hospitalization (OR 0.26 [95% CI:0.11-0.61]; p<0.01). Triage cardiac POCUS scans were not associated with any outcomes. Discussion: Lung POCUS findings detected early in the hospitalization may provide expedient risk stratification for important COVID-19 clinical outcomes, including ICU admission, intubation, or need for oxygen on discharge. A normal admission scan appears protective against adverse outcomes, which may aid in triage decisions of patients.

scholarly journals Point-of-Care Ultrasound Findings and Clinical Outcomes in Patients with COVID-19

2020 ◽  
Vol 33 (11) ◽  
pp. 1416-1417 ◽  
Author(s):  
Rupa L. Iyengar-Kapuganti ◽  
Neil Patel ◽  
Malcolm Anastasius ◽  
Trent She ◽  
Bret P. Nelson ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Ultrasound Findings

scholarly journals Case of ventricular septal rupture following acute myocardial infarction

Ultrasound ◽  
2020 ◽  
Vol 28 (3) ◽  
pp. 196-201
Author(s):  
Natasha M Amorosi ◽  
Alison White
Keyword(s):  
Myocardial Infarction ◽  
Point Of Care ◽  
Initial Point ◽  
Signs And Symptoms ◽  
Adverse Outcomes ◽  
Point Of Care Ultrasound ◽  
Ventricular Septal Rupture ◽  
Long Term Outcomes

Ventricular septal rupture is a rare and potentially fatal complication of transmural myocardial infarction. Early identification utilising transthoracic echocardiography significantly improves long term outcomes in these patients. We report on a case of a 77-year-old male who presented with signs and symptoms of cardiac failure and a loud systolic murmur. The patient underwent an initial point-of-care ultrasound which revealed evidence of a transmural myocardial infarction and a high suspicion of an apical ventricular septal rupture. A complete transthoracic echocardiogram confirmed the septal rupture diagnosis and the patient subsequently underwent surgical repair of the ventricular rupture. This case highlights the role of echocardiography in decreasing adverse outcomes in patients with ventricular septal rupture.

scholarly journals 1415. Use of Adjunctive Steroids in Adults with Encephalitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S515-S515
Author(s):  
Ambreen Allana ◽  
Mohammed Samannodi ◽  
Michael Hansen ◽  
Rodrigo Hasbun
Keyword(s):  
Clinical Outcomes ◽  
Brain Mri ◽  
Tertiary Care ◽  
Brain Magnetic Resonance Imaging ◽  
Adverse Outcomes ◽  
Neurological Deficits ◽  
Icu Admission ◽  
Magnetic Resonance Imaging Mri ◽  
Tertiary Care Hospitals ◽  
The Impact

Abstract Background To describe the use and the impact on clinical outcomes of adjunctive steroids in adults with encephalitis. Methods We conducted a retrospective observational study of 230 adults (age >17 years) who met the international consortium definition for encephalitis. An adverse clinical outcome was defined as a Glasgow outcome score of 1–4. The study took place at three tertiary care hospitals in Houston TX, between August 2008 and September 2017. Results A total of 230 adults with encephalitis were enrolled, out of which 121 (52.6%) received steroids. Adjunctive steroids were given more frequently to those with focal neurological deficits (P = 0.013), had a positive cerebrospinal fluid (CSF) HSV PCR (P = 0.013), required mechanical ventilation (MV) (P = 0.011), required intensive care unit (ICU) admission (P < 0.001), had white matter abnormalities (P = 0.014) or had cerebral edema on the brain magnetic resonance imaging (MRI) (P = 0.003). An adverse outcome was seen in 139 (60.7%) of patients. Predictors for adverse outcomes included a Glasgow coma score (GCS) < 8, fever, seizures, ICU admission, and presence of edema on brain MRI. The use of adjunctive steroids did not impact clinical outcomes (P = 0.521). Independent prognostic factors on logistic regression analysis were edema on brain MRI (7.780 [1.717–35.263] P = 0.008), GCS < 8 (6.339 [1.992–20.168] P = 0.002), and fever (2.601 [1.342–5.038] P = 0.005). Conclusion Adults with encephalitis continues to be associated with significant adverse clinical outcomes in the majority of patients. Adjunctive steroids are used in the sicker patients and it is not associated with improved clinical outcomes. Disclosures All authors: No reported disclosures.

scholarly journals Point-of-Care Lung Ultrasound for COVID-19: Findings and Prognostic Implications From 105 Consecutive Patients

2021 ◽  
Vol 36 (3) ◽  
pp. 334-342 ◽  
Author(s):  
Kosuke Yasukawa ◽  
Taro Minami ◽  
David R. Boulware ◽  
Ayako Shimada ◽  
Ernest A. Fischer
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Prognostic Value ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Respiratory Support ◽  
Point Of Care Ultrasound ◽  
Bilateral Involvement ◽  
Ultrasound Score ◽  
B Lines

Background: The prognostic value of point-of-care lung ultrasound has not been evaluated in a large cohort of patients with COVID-19 admitted to general medicine ward in the United States. The aim of this study was to describe lung ultrasound findings and their prognostic value in patients with COVID-19 admitted to internal medicine ward. Method: This prospective observational study consecutively enrolled 105 hospitalized participants with COVID-19 at 2 tertiary care centers. Ultrasound was performed in 12 lung zones within 24 hours of admission. Findings were assessed relative to 4 outcomes: intensive care unit (ICU) need, need for intensive respiratory support, length of stay, and death. Results: We detected abnormalities in 92% (97/105) of participants. The common findings were confluent B-lines (92%), non-homogenous pleural lines (78%), and consolidations (54%). Large confluent B-lines, consolidations, bilateral involvement, and any abnormality in ≥ 6 areas were associated with a longer hospitalization and need for intensive respiratory support. Large confluent B-lines and bilateral involvement were also associated with ICU stay. A total lung ultrasound score <5 had a negative predictive value of 100% for the need of intensive respiratory support. A higher total lung ultrasound score was associated with ICU need (median total 18 in the ICU group vs. 11 non-ICU, p = 0.004), a hospitalization ≥ 9d (15 vs 10, p = 0.016) and need for intensive respiratory support (18 vs. 8.5, P < 0.001). Conclusions: Most patients hospitalized with COVID-19 had lung ultrasound abnormalities on admission and a higher lung ultrasound score was associated with worse clinical outcomes except death. A low total lung ultrasound score (<5) had a negative predictive value of 100% for the need of intensive respiratory support. Point-of-care ultrasound can aid in the risk stratification for patients with COVID-19 admitted to general wards.

scholarly journals First year internal medicine residents’ self-report point-of-care ultrasound knowledge and skills: what (Little) difference three years make

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tanner Chahley ◽  
Ada W Lam ◽  
Samantha Halman ◽  
Kathryn Watson ◽  
Irene WY Ma
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Internal Medicine Residency ◽  
Self Report ◽  
First Year ◽  
Learning Needs ◽  
Point Of Care Ultrasound ◽  
Internal Medicine Residents ◽  
Study Support ◽  
B Lines

Abstract Background With increasing availability of point-of-care ultrasound (POCUS) education in medical schools, it is unclear whether or not learning needs of junior medical residents have evolved over time. Methods We invited all postgraduate year (PGY)-1 residents at three Canadian internal medicine residency training programs in 2019 to complete a survey previously completed by 47 Canadian Internal Medicine PGY-1 s in 2016. Using a five-point Likert scale, participants rated perceived applicability of POCUS to the practice of internal medicine and self-reported skills in 15 diagnostic POCUS applications and 9 procedures. Results Of the 97 invited residents, 58 (60 %) completed the survey in 2019. Participants reported high applicability but low skills across all POCUS applications and procedures. The 2019 cohort reported higher skills in assessing pulmonary B lines than the 2016 cohort (2.3 ± SD 1.0 vs. 1.5 ± SD 0.7, adjusted p-value = 0.01). No other differences were noted. Conclusions POCUS educational needs continue to be high in Canadian internal medicine learners. The results of this needs assessment study support ongoing inclusion of basic POCUS elements in the current internal medicine residency curriculum.

scholarly journals Association of hyperlipidemia and statin use with severity of COVID-19

2020 ◽  
Author(s):  
Wilnard YT Tan ◽  
Barnaby E Young ◽  
David Chien Lye ◽  
Daniel EK Chew ◽  
Rinkoo Dalan
Keyword(s):  
Clinical Outcomes ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Invasive Mechanical Ventilation ◽  
Statin Treatment ◽  
Supplemental Oxygen ◽  
Logistic Regression Models ◽  
Icu Admission ◽  
Treatment Models ◽  
Statin Use

Abstract Background and Aims: We aim to study the association of hyperlipidemia and statin use with COVID-19 severity.Methods: We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤94% requiring supplemental oxygen, intensive-care unit (ICU) admission , invasive mechanical-ventilation and death. Logistic regression models were used to study the association between hyperlipidemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined , in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05.Results: One hundred fifty-six (21.8%) patients had hyperlipidemia and 97% were on statins. There were no significant associations between hyperlipidemia and clinical outcomes. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: b-0.12(-0.23,-0.01); p=0.028). There were no other significant differences in other outcomes.Conclusion: Treated hyperlipidemia was not an independent risk factor for severe COVID-19. Statin use independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.

scholarly journals Potential Use of Remote Telesonography as a Transformational Technology in Underresourced and/or Remote Settings

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Linping Pian ◽  
Lawrence M. Gillman ◽  
Paul B. McBeth ◽  
Zhengwen Xiao ◽  
Chad G. Ball ◽  
...  
Keyword(s):  
Urban Areas ◽  
Point Of Care ◽  
Traumatic Injury ◽  
Trauma System ◽  
Cost Effective ◽  
Point Of Care Ultrasound ◽  
Care Providers ◽  
Mortality And Morbidity ◽  
Medical Centers ◽  
Human Exploration

Mortality and morbidity from traumatic injury are twofold higher in rural compared to urban areas. Furthermore, the greater the distance a patient resides from an organized trauma system, the greater the likelihood of an adverse outcome. Delay in timely diagnosis and treatment contributes to this penalty, regardless of whether the inherent barriers are geographic, cultural, or socioeconomic. Since ultrasound is noninvasive, cost-effective, and portable, it is becoming increasingly useful for remote/underresourced (R/UR) settings to avoid lengthy patient travel to relatively inaccessible medical centers. Ultrasonography is a user-dependent, technical skill, and many, if not most, front-line care providers will not have this advanced training. This is particularly true if care is being provided by out-of-hospital, “nontraditional” providers. The human exploration of space has forced the utilization of information technology (IT) to allow remote experts to guide distant untrained care providers in point-of-care ultrasound to diagnose and manage both acute and chronic illness or injuries. This paradigm potentially brings advanced diagnostic imaging to any medical interaction in a setting with internet connectivity. This paper summarizes the current literature surrounding the development of teleultrasound as a transformational technology and its application to underresourced settings.

scholarly journals Use of Point-of-Care Ultrasound for Evaluation of Extravascular and Intravascular Fluid Status in Pediatric Patients Maintained on Chronic Hemodialysis

2021 ◽  
pp. 1-7
Author(s):  
Orly Haskin ◽  
Yafa Falush ◽  
Miriam Davidovits ◽  
Hadas Alfandary ◽  
Shelly Levi ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Pediatric Patients ◽  
Fluid Overload ◽  
Point Of Care ◽  
Vena Cava ◽  
Chronic Hemodialysis ◽  
Point Of Care Ultrasound ◽  
Sonographic Evaluation ◽  
Fluid Status ◽  
B Lines

<b><i>Aims:</i></b> Traditional methods that use clinical parameters to determine dry weight in hemodialysis patients are inaccurate. This study aimed to compare clinical assessment of fluid status to sonographic parameters of fluid status in pediatric patients undergoing chronic hemodialysis. <b><i>Methods:</i></b> In a prospective observational study, pediatric patients maintained on chronic hemodialysis (ages 2.3–20 years) were evaluated clinically and sonographically before and after dialysis at 6 consecutive sessions. Sonographic parameters examined were number of lung B-lines as a measure of extravascular volume and inferior vena cava (IVC)/aorta ratio as a measure of intravascular volume. Clinical assessment of fluid status was compared to sonographic assessment. <b><i>Results:</i></b> Twelve patients were evaluated during 72 dialysis sessions. Sonographic parameters were significantly lower post-dialysis than pre-dialysis (B-lines number 4.5 ± 5 vs. 7.69 ± 7.46, <i>p</i> &#x3c; 0.0001; IVC/aorta ratio 0.9 ± 0.2 vs. 1.1 ± 0.2, <i>p</i> &#x3c; 0.0001, respectively). Ultrafiltration volume correlated with change in B-lines number during dialysis (<i>r</i> = 0.39, <i>p</i> &#x3c; 0.01). Percent of blood volume drop correlated with post-dialysis IVC/aorta ratio (<i>r</i> = 0.48, <i>p</i> &#x3c; 0.001). A higher percent of symptomatic episodes occurred with post-dialysis IVC/aorta ratio &#x3c;0.8 versus ≥0.8 (39.1 vs. 15.2%, <i>p</i> = 0.036). Four patients were hypertensive, a clinical parameter implying fluid overload, in only one sonographic evaluation indicated fluid overload. Eight patients were clinically determined to be euvolemic, in three of them sonographic evaluation discovered covert fluids. <b><i>Conclusion:</i></b> Bedside ultrasound is a single modality that can be used to assess both extravascular and intravascular fluid status. It may contribute to clinical decisions differentiating fluid-related versus fluid-unrelated hypertension and identifying patients with covert fluids.

scholarly journals Point‐of‐Care Ultrasound Predicts Clinical Outcomes in Patients With COVID ‐19

2021 ◽  
Author(s):  
Andre Kumar ◽  
Isabel Weng ◽  
Sally Graglia ◽  
Thomas Lew ◽  
Kavita Gandhi ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Point Of Care ◽  
Point Of Care Ultrasound
Sign in / Sign up

Export Citation Format

Share Document