Pocus as a tool to avoid diagnostic errors in covid-19 era

X-ray flips and wrong labelling has been uncomfortably common, and often results in wrong side intervention. Wrong side surgery is indeed the most dramatic and visible form of human errors. Until the 1999 Institute of Medicine report ‘To Err is Human’, the medical fraternity was largely unaware of such preventable medical errors and near misses. We herein, describe a case where X-ray flip and mislabelling led to wrong side intervention in a COVID-19 ICU. Active errors in human performance are inevitable while practising medicine in the current COVID-19 pandemic where difficulties in performing comprehensive systemic examination with the protective gear on, long working hours, work stress, emotions, and fatigue interplay with the errors in technology and increase the chances of errors. We propose the use of point of care ultrasound (POCUS) in COVID-19 ICU’s to aid in the diagnosis and management.

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The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study

The Ultrasound Journal ◽

10.1186/s13089-021-00205-x ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Matthew G. Hanson ◽

Barry Chan

Keyword(s):

Pericardial Effusion ◽

Point Of Care ◽

Physical Exam ◽

Right Atrial ◽

Point Of Care Ultrasound ◽

X Ray ◽

Average Systolic Blood Pressure ◽

Time To Diagnosis ◽

Clinically Significant ◽

The Impact

Abstract Background Symptomatic pericardial effusion (PCE) presents with non-specific features and are often missed on the initial physical exam, chest X-ray (CXR), and electrocardiogram (ECG). In extreme cases, misdiagnosis can evolve into decompensated cardiac tamponade, a life-threatening obstructive shock. The purpose of this study is to evaluate the impact of point-of-care ultrasound (POCUS) on the diagnosis and therapeutic intervention of clinically significant PCE. Methods In a retrospective chart review, we looked at all patients between 2002 and 2018 at a major Canadian academic hospital who had a pericardiocentesis for clinically significant PCE. We extracted the rate of presenting complaints, physical exam findings, X-ray findings, ECG findings, time-to-diagnosis, and time-to-pericardiocentesis and how these were impacted by POCUS. Results The most common presenting symptom was dyspnea (64%) and the average systolic blood pressure (SBP) was 120 mmHg. 86% of people presenting had an effusion > 1 cm, and 89% were circumferential on departmental echocardiogram (ECHO) with 64% having evidence of right atrial systolic collapse and 58% with early diastolic right ventricular collapse. The average time-to-diagnosis with POCUS was 5.9 h compared to > 12 h with other imaging including departmental ECHO. Those who had the PCE identified by POCUS had an average time-to-pericardiocentesis of 28.1 h compared to > 48 h with other diagnostic modalities. Conclusion POCUS expedites the diagnosis of symptomatic PCE given its non-specific clinical findings which, in turn, may accelerate the time-to-intervention.

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The Role of Lung Ultrasound Before and During the COVID-19 Pandemic: A review article

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211006122842 ◽

2021 ◽

Vol 17 ◽

Author(s):

Mustafa J. Musa ◽

Mohamed Yousef ◽

Mohammed Adam ◽

Awadalla Wagealla ◽

Lubna Boshara ◽

...

Keyword(s):

Lung Ultrasound ◽

Point Of Care ◽

Power Doppler ◽

Doppler Imaging ◽

Point Of Care Ultrasound ◽

Institute Of Medicine ◽

Pubmed Central ◽

Contrast Enhanced ◽

Ultrasound Findings

: Lung ultrasound [LUS] has evolved considerably over the last years. The aim of the current review is to conduct a systematic review reported from a number of studies to show the usefulness of [LUS] and point of care ultrasound for diagnosing COVID-19. A systematic search of electronic data was conducted including the national library of medicine, and the national institute of medicine, PubMed Central [PMC] to identify the articles depended on [LUS] to monitor COVID-19. This review highlights the ultrasound findings reported in articles before the pandemic [11], clinical articles before COVID-19 [14], review studies during the pandemic [27], clinical cases during the pandemic [5] and other varying aims articles. The reviewed studies revealed that ultrasound findings can be used to help in the detection and staging of the disease. The common patterns observed included irregular and thickened A-lines, multiple B-lines ranging from focal to diffuse interstitial consolidation, and pleural effusion. Sub-plural consolidation is found to be associated with the progression of the disease and its complications. Pneumothorax was not recorded for COVID-19 patients. Further improvement in the diagnostic performance of [LUS] for COVID-19 patients can be achieved by using elastography, contrast-enhanced ultrasound, and power Doppler imaging.

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Simple Pneumonia or Something More?: A Case Report and Discussion of Unexpected Empyema Identified by Point-of-Care Ultrasound

CJEM ◽

10.1017/cem.2015.71 ◽

2015 ◽

Vol 18 (5) ◽

pp. 391-394

Author(s):

Michael Romano ◽

Tomislav Jelic ◽

Jordan Chenkin

Keyword(s):

Emergency Department ◽

Point Of Care ◽

Fluid Collection ◽

Chest Ct ◽

Point Of Care Ultrasound ◽

X Ray ◽

Level Of Consciousness ◽

Chest X Ray ◽

Ultrasound Assessment ◽

Higher Sensitivity

AbstractThere is evidence to suggest that point-of-care ultrasound assessment of the lungs has a higher sensitivity and specificity than chest radiography for the diagnosis of pneumonia. It is unknown if the same is true for pneumonia complications. We present and discuss the case of a 61-year-old woman who presented to the emergency department with confusion, decreased level of consciousness, and signs of sepsis. A chest x-ray revealed a right sided infiltrate. An ultrasound of the patient’s lungs was performed, and revealed a complex loculated fluid collection consistent with an empyema. A chest CT confirmed the diagnosis, and immediate percutaneous drainage was performed.

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Lung Ultrasound as a New Technique for Diagnosis of Neonatal Respiratory Diseases

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.37.4.224 ◽

2018 ◽

Vol 37 (4) ◽

pp. 224-232 ◽

Cited By ~ 1

Author(s):

Yasser N. Elsayed

Keyword(s):

Lung Disease ◽

Lung Ultrasound ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Ultrasound Images ◽

X Ray ◽

The Past ◽

Neonatal Lung ◽

Chest X Ray ◽

A New Technique

Point-of-care ultrasound in the NICU is becoming more commonplace and is now used for a number of indications. Over the past ten years, the use of ultrasound as an alternative to a chest x-ray for the diagnosis of neonatal lung disease has been explored, and protocols were developed to refine the interpretation of ultrasound images in neonatal lung disease. The purpose of this column is to briefly explain the physics of ultrasound and describe the application of ultrasound to neonatal lung assessment.

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Diagnosis of metacarpal fracture with equivocal x-ray by point-of-care ultrasound: a case report

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2014.01.018 ◽

2014 ◽

Vol 32 (7) ◽

pp. 821.e1-821.e3 ◽

Cited By ~ 3

Author(s):

Jennifer Ruskis ◽

Tobias Kummer

Keyword(s):

Case Report ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Metacarpal Fracture ◽

X Ray

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Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-137832 ◽

2020 ◽

Vol 97 (1143) ◽

pp. 55-58

Author(s):

Michael Reaume ◽

Mehdi Farishta ◽

Joseph A Costello ◽

Tyler Gibb ◽

Thomas A Melgar

Keyword(s):

Internal Medicine ◽

Critical Care ◽

Family Medicine ◽

Point Of Care ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Radiology Department ◽

Point Of Care Ultrasound ◽

Study Objective ◽

Diagnostic Use

PurposeThe purpose of this study is to identify the extent of diagnostic error lawsuits related to point-of-care ultrasound (POCUS) in internal medicine, paediatrics, family medicine and critical care, of which little is known.MethodsWe conducted a retrospective review of the Westlaw legal database for indexed state and federal lawsuits involving the diagnostic use of POCUS in internal medicine, paediatrics, family medicine and critical care. Retrieved cases were reviewed independently by three physicians to identify cases relevant to our study objective. A lawyer secondarily reviewed any cases with discrepancies between the three reviewers.ResultsOur search criteria returned 131 total cases. Ultrasound was mentioned in relation to the lawsuit claim in 70 of the cases returned. In these cases, the majority were formal ultrasounds performed and reviewed by the radiology department, echocardiography studies performed by cardiologists or obstetrical ultrasounds. There were no cases of internal medicine, paediatrics, family medicine or critical care physicians being subjected to adverse legal action for their diagnostic use of POCUS.ConclusionOur results suggest that concerns regarding the potential for lawsuits related to POCUS in the fields of internal medicine, paediatrics, family medicine and critical care are not substantiated by indexed state and federal filed lawsuits.

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Case series: Point-of-Care Ultrasound Conducted by Medical Students During their First Clinical Rotation Changes Patients’ Primary Diagnosis and Management

International Journal of Medical Students ◽

10.5195/ijms.2021.558 ◽

2021 ◽

Vol 9 (1) ◽

pp. 15-20

Author(s):

Re'em Sadeh ◽

Tomer Gat ◽

Omer Kaplan ◽

Tzvika Porges ◽

Lior Zeller ◽

...

Keyword(s):

Medical Students ◽

Point Of Care ◽

Case Series ◽

Medical Schools ◽

Point Of Care Ultrasound ◽

Additional Contribution ◽

Clinical Rotation ◽

X Ray ◽

First Case ◽

Chest X Ray

Background: As point-of-care ultrasound (POCUS) becomes a standard of care procedure, medical schools around the world have started to seek the integration of POCUS courses into their curricula. This puts medical students in a unique position as they are trained in an area in which many physicians lack knowledge. This case series provides a glimpse into the capabilities of POCUS even when used by medical students. Methods: Fourth-year medical students at Ben-Gurion University of the Negev performed numerous POCUS exams during their first clinical rotation at Soroka University Medical Center in Israel. All students completed a course in basic POCUS training and were evaluated in a brief practical exam before entering their first clinical rotation. Four of the cases in which the students took part are presented in this case series. Results: The POCUS exam in the first case discovered pulmonary embolism in addition to the diagnosis of Cushing disease. In the second case, endocarditis could have been diagnosed three days earlier had a POCUS exam been performed. Case 3 demonstrates the additional contribution of POCUS to the decision-making process carried out by physicians and its superiority in quantifying and diagnosing pleural effusion compared to chest X-Ray. Case 4 indicated that POCUS is preferable over chest X-ray and auscultation for the diagnosis of pulmonary edema. Conclusion: This case series may emphasize the capabilities POCUS has when utilized in the standard physical examination and the importance of incorporating POCUS instruction in medical schools for new physicians to acquire this skill.

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156. Correlation Between WHO (World Health Organization) Case Definition of Severe Pneumonia and Lung POCUS (Point of Care Ultrasound) vs Chest X-ray (CXR) Findings to Diagnose Pediatric Community-Acquired Pneumonia (CAP) in Limited Resource Settings

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.156 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S94-S95

Author(s):

Ingrid Y Camelo ◽

Rachel Pieciak ◽

Ilse castro-aragon ◽

Bindu Setty ◽

Lauren Etter ◽

...

Keyword(s):

Low Income ◽

Point Of Care ◽

Severe Pneumonia ◽

Limited Resource ◽

Case Definition ◽

World Health ◽

Point Of Care Ultrasound ◽

X Ray ◽

Chest X Ray ◽

Definition Of

Abstract Background Childhood pneumonia is one of the leading causes of death in low-income countries. The diagnosis of pediatric pneumonia is a critical epidemiological duty for treatment effectiveness and vaccine surveillance. Previous studies have demonstrated an important lack in correlation between CXR findings and the clinical WHO case definition of severe pneumonia. Lung Point of Care Ultrasound (POCUS) has demonstrated in multiple studies to be more sensitive and specific for diagnosing pneumonia in the pediatric population. With no exposure to radiation, extensive availability in limited-resource settings, and easy interpretation, this modality can be a breakpoint in making a more accurate correlation between pneumonia clinical findings and diagnostic imaging. Methods 50 children from 1-59 months meeting the WHO case definition of severe pneumonia were enrolled at the Emergency Department at University Teaching Hospital (UTH) in Lusaka, Zambia. Children underwent lung POCUS and CXR. Correlation between symptoms and all abnormalities (consolidation, effusion, and interstitial patterns) seen in both imaging modalities were analyzed by calculating the proportion of children with abnormalities on CXR and ultrasound. Each participant was assigned a score based on findings. 0 = normal, 1 = consolidation only, 2 = Consolidation and non-consolidation (interstitial and/or effusion) and 3 = non-consolidation (interstitial and/or effusion) only. Results 44 (90%) of children had abnormalities on CXR and 46 (94%) on POCUS. Five children (10%) had normal findings on CXR vs 3 (6%) on Lung POCUS. 4 (8%) had consolidation only on CXR vs 0 (0%) on POCUS. 19 (39%) had consolidation and non-consolidation (interstitial and/or effusion) on CXR vs. 20 (41%) on POCUS. 21 (43%) had non-consolidation (interstitial and/or effusion) only on CXR vs. 26 (53%) on POCUS. Figure 1. Scores Asigned Based on Imaging Findings for CXR and Lung POCUS Figure 2. Chest X Ray Anterior Posterior (AP) view showing Bilareral Interstitial Pattern Figure 3. Lung POCUS (Point of Care Ultrasound) findings of bilateral Consolidation and non-consolidation pattern and bilateral interstitial pattern (only finding on CXR) Conclusion More children with clinical pneumonia had normal findings on CXR than on POCUS. POCUS was a better imaging technique to show consolidation and non-consolidation patterns than CXR. The higher proportion of children diagnosed with consolidation and non-consolidation patterns on POCUS suggest that CXR might not be the ideal gold standard to diagnose pneumonia in children. Disclosures All Authors: No reported disclosures

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