scholarly journals Evidence base for point-of-care ultrasound (POCUS) for diagnosis of skull fractures in children: a systematic review and meta-analysis

2020 ◽  
pp. emermed-2020-209887
Author(s):  
Georgios Alexandridis ◽  
Eva W Verschuuren ◽  
Arthur V Rosendaal ◽  
Danny A Kanhai
Keyword(s):  
Head Injury ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Point Of Care ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Point Of Care Ultrasound ◽  
Skull Fractures ◽  
Fractures In Children

BackgroundBlunt head trauma is a common presentation to emergency departments (EDs). Identifying skull fractures in children is important as they are known factor of risk for traumatic brain injury (TBI). Currently, CT is the reference standard for diagnosing skull fractures and TBIs in children. Identifying skull fractures with point-of-care ultrasound (POCUS) may help risk-stratify children for TBI following blunt trauma. The purpose of this study is to evaluate the sensitivity, specificity, positive predictive value and negative predictive value of POCUS in identifying skull fractures in children.MethodsA systematic search was performed on 17 July 2020 in Ovid Medline, Cochrane Library, Google Scholar, Web of Science and Embase. Prospective studies reporting skull fractures diagnosed with ultrasound in children younger than 18 years due to blunt head injury were included. Studies that did not confirm the fracture with CT were excluded. The quality of studies was evaluated using the QUADAS-2 tool. Data were extracted from the eligible studies to calculate outcomes such as sensitivity and specificity; when possible overall outcomes were calculated.ResultsSeven studies were included. All eligible studies included patients for whom the decision to perform a CT scan was made in advance. Overall, the included studies demonstrated low risk of bias or had minor concerns regarding risk of bias. The pooled data (n=925) demonstrated a sensitivity of 91%, specificity of 96%, positive predictive value of 88% and negative predictive value of 97%.ConclusionThe included studies demonstrate minor methodological limitations. Overall, the evidence suggests that POCUS is a valid option for diagnosing skull fractures in children visiting the ED after blunt head injury.

scholarly journals Diagnostic accuracy of point-of-care lung ultrasound in COVID-19

2020 ◽  
pp. emermed-2020-210125
Author(s):  
Svenja L Haak ◽  
Iris JE Renken ◽  
L Cara Jager ◽  
Heleen Lameijer ◽  
Brigitta (Britt) YM van der Kolk
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Point Of Care ◽  
Trauma Centre ◽  
Point Of Care Ultrasound ◽  
Current Standard ◽  
Cardiopulmonary Disease ◽  
Pulmonary Manifestations

BackgroundA promising modality for diagnosing pulmonary manifestations of COVID-19 in the emergency department (ED) is point-of-care ultrasound (POCUS) of the lungs. The currently used PCR as well as chest X-ray and CT scanning have important disadvantages. The aim of this study is to evaluate the diagnostic accuracy of POCUS in patients with suspected pulmonary manifestations of COVID-19 in the ED.MethodsThis prospective diagnostic accuracy study was conducted at the ED of our non-academic level 1 trauma centre (Isala, Zwolle, the Netherlands). Patients were enrolled between 14 April and 22 April 2020. Patients (aged ≥16 years) with suspected COVID-19 presenting to the ED underwent POCUS. All patients received current standard of care, including PCR (naso-oropharyngeal swab). Outcome of POCUS was compared with PCR or CT scan outcome to determine diagnostic accuracy. Diagnostic accuracy measures were calculated using 2×2 contingency tables.Results100 patients were eligible to participate in this study, data of 93 patients were analysed. 27 (29%) patients were found positive for COVID-19 by PCR or CT. POCUS had a sensitivity of 89% (95% CI 70% to 97%), specificity of 59% (95% CI 46% to 71%), negative predictive value of 93% (95% CI 79% to 98%) and positive predictive value of 47% (95% CI 33% to 61%). In a subgroup of patients without previous cardiopulmonary disease (n=37), POCUS had a sensitivity of 100% (95% CI 70% to 100%), specificity of 76% (95% CI 54% to 90%), negative predictive value of 100% (95% CI 79% to 100%) and positive predictive value of 67% (95% CI 41% to 86%).ConclusionPOCUS of the lungs could serve as a valuable, radiation-free tool for excluding pulmonary manifestations of COVID-19 in patients in the ED at the point of assessment, especially in patients without previous cardiopulmonary disease.Trial registrationDutch Trial Register, No: NTR8544.

Point-of-care ultrasound for peripherally inserted central catheter monitoring: a pilot study

2019 ◽  
Vol 47 (9) ◽  
pp. 991-996 ◽  
Author(s):  
Patrick Motz ◽  
Amelie Von Saint Andre Von Arnim ◽  
Ramesh S. Iyer ◽  
Shilpi Chabra ◽  
Maggie Likes ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pilot Study ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Phased Array ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Standardized Protocol

Abstract Objective To assess the feasibility and accuracy of point-of-care ultrasound (POCUS) in monitoring peripherally inserted central catheter (PICC) location in neonates by non-radiologist physicians. Methods A prospective cohort study compared PICC localization by ultrasound in neonates with a recent radiograph. The ultrasound exam was performed using a standardized protocol with 13–6 MHz linear and 8–4 MHz phased array transducers by a neonatal-perinatal fellow who was blinded to PICC location on the radiograph. Results Of the 30 neonates included, 96.6% (n = 29) were preterm, with 63.3% (n = 19) weighing <1500 g. Nighty-four percent (n = 94) of ultrasound scans matched the radiograph report. The protocol had a sensitivity of 0.97, specificity of 0.66 and positive predictive value of 0.98. Conclusion Limited ultrasound exams to monitor PICC position in neonates using a standardized protocol by non-radiologist physicians are feasible and accurate in a single ultrasound user. Further study in multiple providers is needed before widespread use.

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.

Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age

2018 ◽  
Vol 196 ◽  
pp. 230-236.e2 ◽  
Author(s):  
Niccolò Parri ◽  
Bradley J. Crosby ◽  
Lisa Mills ◽  
Zachary Soucy ◽  
Anna Maria Musolino ◽  
...  
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Skull Fractures ◽  
Fractures In Children

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

PEDIATRICS ◽  
2013 ◽  
Vol 131 (6) ◽  
pp. e1757-e1764 ◽  
Author(s):  
J. E. Rabiner ◽  
L. M. Friedman ◽  
H. Khine ◽  
J. R. Avner ◽  
J. W. Tsung
Keyword(s):  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Skull Fractures ◽  
Fractures In Children

scholarly journals The Use of Active Melioidosis Detect TM in Early Diagnosis of Melioidosis in Hospital Tengku Ampuan Afzan and Hospital Sultanah Nur Zahirah

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Wan Nurliyana Wan Ramli
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Point Of Care ◽  
Rapid Test ◽  
High Specificity ◽  
Culture Method ◽  
Lower Sensitivity ◽  
Spot Urine

Introduction: Melioidosis is endemic in Malaysia and an important cause of sepsis. Current gold standard for diagnosis is by culture method,but its long procedure will delay the treatment leading to hospital-related mortality.Thus,a good rapid test is needed to reduce its mortality burden. Recently, Active Melioidosis Detect (AMD) have been shown to be useful. Objectives: (1)To measure the sensitivity and specificity of AMD. (2)To study the sensitivity and specificity of early morning urine AMD compared to spot urine AMD. Materials and method: A prospective crosssectional study of clinically suspected melioidosis patients in HTAA and HSNZ from April until December 2018. Blood and urine samples were tested with AMD. Test results were analysed for sensitivity, specificity,positive predictive value and negative predictive value. Results: A total of 89 patients were included in this study.The mean age is 52 years old, and 56.3% were male gender.64% of patients have diabetes mellitus.11 patients have positive blood culture for Bukholderia pseudomallei, 4 of them were tested positive for AMD.3 of them presented with septic shock (3.4%), however none died.The sensitivity of the AMD was 36.4% ([95% CI 12.4 to 68.4]) and the specificity was 66.7% ( [95% CI 46.0 to 82.8]) in all samples, with positive predictive value of 30.7% and negative predictive value of 72%.Blood samples have lower sensitivity of 9.1% ([95% CI 4.8 to 42.9]) with high specificity of 100% ([95% CI 84.5 to 100]). Urine spot samples have higher sensitivity compared to serum and morning urine, with 36.4% ([95%CI 12.4 to 68.4]) and specificity of 88.9% ([95% CI 69.7 to 97.1]). Conclusion: From this pilot study, this test requires further evaluation before incorporating as point of care assay.

scholarly journals Point of Care Tests VerifyNow P2Y12 and INNOVANCE PFA P2Y Compared to Light Transmittance Aggregometry After Fibrinolysis

2018 ◽  
Vol 24 (7) ◽  
pp. 1109-1116 ◽  
Author(s):  
Vincent Roule ◽  
Pierre Ardouin ◽  
Yohan Repessé ◽  
Agnès Le Querrec ◽  
Katrien Blanchart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Platelet Reactivity ◽  
Point Of Care ◽  
Light Transmittance ◽  
Light Transmittance Aggregometry ◽  
St Elevation ◽  
Point Of Care Tests

Detection of high on-treatment platelet reactivity (HPR) by point-of-care tests has not been validated after successful fibrinolysis for ST-elevation myocardial infarction. We assessed the validity of the point-of-care VerifyNow P2Y12 (VN) and INNOVANCE PFA P2Y (PFA) tests on HPR compared to light transmittance aggregometry (LTA) in these patients. The HPR was identified in 10 (34.5%) patients, 15 (51.7%) patients, and 14 (50%) patients using LTA, VN, and PFA, respectively. Discrepancies were observed between the tests despite significant correlations between platelet reactivity measures by LTA and VN ( r = 0.74; P < .0001) and LTA and PFA ( r = .75; P < .0001). Compared to LTA, VN and PFA were associated with a 92% and 53% and 92% and 64% positive predictive value (PPV) and negative predictive value (NPV), respectively, in detecting HPR. When combined, VN and PFA results yielded 90% and 100% PPV and NPV values if discrepancies between the 2 tests were considered as non-HPR. The VN or PFA identify patients without HPR correctly but overestimate the proportion of HPR patients. The association of the 2 tests, in case of HPR, improves the accuracy of the detection of HPR.

scholarly journals A Systematic Review of Short Screening Instruments for Suicidal Behaviour in Primary Care

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Lukaschek K ◽  
◽  
Frank M ◽  
Gensichen J ◽  
Halfter K ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Time Management ◽  
Suicidal Behaviour ◽  
Risk Of Bias ◽  
Initial Assessment ◽  
Cochrane Library ◽  
Screening Instruments ◽  
Brief Screening

Background: Due to strict time management General Practitioners (GPs) prefer short instruments when identifying suicidal behaviour in their patients. We summarize the available studies reporting diagnostic accuracy of brief instruments for suicidal behaviour in primary care. Method: Databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. We included studies on primary care patients or participants from the general population. Suicidal behaviour was the defined target condition. With respect to the applicability in a primary care setting we included only studies assessing brief screening instruments; a brief instrument was defined as having no more than twelve items. We assessed sensitivity, specificity, and positive and negative predictive value. Results: A total of 9,969 studies was identified; of those, six fulfilled all strong criteria and were included. The range of sensitivity was 0.26-1.00, specificity was 0.64-0.99, positive predictive value 0.06-0.91, negative predictive value 0.86-1.00. Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 0.80 and specificity of 0.50 with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions: Brief screening instruments can support ruling-out suicidality, but are less suitable for ruling-in. They may support GPs in an initial assessment, but in case of a positive test result, a valid diagnostic assessment should be done by a structured clinical interview.

scholarly journals Added value of diffusion-weighted MRI in assessment of pleural lesions

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Youssriah Yahia Sabri ◽  
Ikram Hamed Mahmoud ◽  
Lamis Tarek El-Gendy ◽  
Mohamed Raafat Abd El-Mageed ◽  
Sally Fouad Tadros
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Added Value ◽  
Adc Value ◽  
Pleural Diseases ◽  
Conventional Mri ◽  
Malignant Lesions

Abstract Background There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions. Results Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001). Conclusion Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

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