POCUS journal最新文献

This study evaluated the effectiveness, retention, engagement, and acceptability of adaptive spaced education (spacED) for improving the accuracy of point of care ultrasound (POCUS) image interpretation by medical students. From July 2022-May 2023, students (n=36) were randomized into two groups and each assigned 50 unique POCUS cases: cardiac/vascular or lung/FAST. Each one served as the control for the other group. We measured effectiveness (% posttest 1 - % pretest), six-month retention (% posttest 2 - % posttest 1), engagement (% cases completed), and acceptability (% would recommend). Twenty-nine students (81%) completed the study. On average, 38.6% of cases were completed over the six-month study period. There was a significant increase in test scores covering FAST (Focused Assessment with Sonography in Trauma) (+18%), lung (+25%), and vascular (+23%, all p<0.01). Six-month FAST and lung scores did not have significant loss (+3% and -10%, p >0.05). Acceptability was high; 96% of students indicated they would participate again. Despite an imperfect case completion rate, for some applications, spacED was an effective, long-lasting, and acceptable method for teaching POCUS interpretation to medical students.

Background: Point of care ultrasound (POCUS) is increasingly recognized as a valuable tool for mediastinal assessment in children, particularly in resource-limited settings where advanced radiological options such as computed tomography (CT) scans are often unavailable. In high-income countries, POCUS is gaining traction as a complementary imaging method, offering a safer, radiation-free alternative.

Methods: To overcome the operator-dependent nature of mediastinal POCUS, a standardized protocol was developed. The protocol includes clear techniques and detailed descriptions of normal and pathological findings, aiming to enhance consistency and diagnostic accuracy.

Results: The standardized protocol improved reliability in mediastinal POCUS assessments, especially in the context of paediatric pulmonary tuberculosis, a condition often marked by lymph node involvement. Given the challenges of obtaining respiratory samples in children and their typically low diagnostic yield, POCUS emerged as a particularly suitable diagnostic modality.

Conclusions: Mediastinal POCUS, guided by a standardized protocol, represents a safe, affordable, point-of-care, and non-ionizing option for identifying mediastinal lymphadenopathy. Its application holds promise for improving the diagnosis of paediatric tuberculosis, especially in settings with limited access to advanced radiological imaging.

Acute right lower quadrant (RLQ) pain is a common presenting complaint in emergency departments among young women. The SHARP Exam is a novel point of care ultrasound (POCUS) protocol designed to aid in the evaluation of undifferentiated, acute, right-sided, lower abdominal pain in women of child-bearing age. The SHARP Exam is both an acronym ([S]ono [H]er [A]bdomen for [R]ight-sided [P]ain) and a diagnostic tool for emergency physicians to focus on specific pathology ([S]ize of ovary, [H]ydronephrosis, [A]ppendicitis, [R]ight upper quadrant free fluid, [P]regnancy). It is an easily reproducible, cost-effective, and non-invasive study that may expedite risk stratification, diagnosis, and treatment of several emergent conditions.

Background: Understanding the intravascular volume status in critically ill children is challenging. Central venous pressure (CVP) is commonly used but is invasive. Assessment of both the inferior vena cava (IVC) and the internal jugular vein (IJV) by point of care ultrasound (POCUS) have shown significant correlation with CVP in adults. Limited data exists in pediatric patients, especially with IJV measurements. This study aims to correlate IJV POCUS with CVP in mechanically ventilated post-operative children following congenital heart disease surgery.

Methods: This prospective study was conducted in the pediatric cardiac critical care unit at a tertiary children's hospital. In addition to other variables, IJV/common carotid artery (CCA) ratio at inspiration and expiration was calculated using the largest diameters of both vessels. The IJV distensibility index (%) was calculated as the ratio of difference in maximal IJV diameter during inspiration and minimal IJV expiratory diameter to minimal IJV expiratory diameter × 100. CVP was obtained prior to POCUS measurements. The association between CVP and the IJV/CCA ratio, as well as IJV distensibility, were assessed using correlation coefficients and 95% confidence intervals.

Results: Thirty-one patients were included, with a median age of 2 months (IQR [0, 6]) and median CVP value of 8.5 mm Hg (IQR 6-11). No significant correlations were found between CVP and IJV/CCA ratio (R= 0.030 p= 0.87) and IJV distensibility index (R= -0.19 p= 0.31).

Conclusions: Although utilizing IJV POCUS to assess volume status may be advantageous given the limited access to IVC measurements in post-operative pediatric cardiac patients, our preliminary data suggests limited utility. Larger-scale studies are needed to establish a more definitive relationship between these variables.

Minor abdominal blunt trauma is a common pediatric emergency department presentation. Contrast-enhanced computed tomography (CECT) is the current gold standard imaging modality for identifying abdominal parenchymal injuries. Contrast-enhanced ultrasound (CEUS) has been suggested as a radiation-sparing alternative. Here we describe, for the first time, the use of pediatric emergency physician-performed CEUS in the evaluation of minor abdominal trauma in a child. The use of CEUS informed the decision-making process in this case and ultimately led to the diagnosis of an adrenal hemorrhage.

Peer review is a fundamental element of the modern scientific publishing process. It serves an important role in evaluating the quality of research and refining submitted manuscripts into accurate and impactful contributions to the existing scientific literature. Over the last two decades, opportunities for publication have skyrocketed, and the demand for peer reviewers has grown exponentially. Although the peer review process provides significant benefits, recruiting individuals as peer reviewers can be challenging. The most common obstacles include the time commitment needed to provide meaningful reviews and uncertainty about how to prepare a cohesive and beneficial peer review. This article offers prospective peer reviewers structured guidance to build confidence and enable them to perform effective reviews.

A "lung point" is the interface between present and absent lung sliding artifacts identified by point of care ultrasound (POCUS). This finding has long been considered highly specific for pneumothorax, with certain studies citing a specificity as high as 100%. More recently, multiple cases that mimic the lung point have been reported. Here, we present a patient case with bilateral lung points in the absence of pneumothorax. We reviewed lung point mimics and explored the conditions that caused this finding without pneumothorax.

Background: Despite abundant literature supporting the diagnostic utility of lung point of care ultrasound (POCUS) in inpatient settings, there is limited data on the feasibility and utility of lung POCUS in pulmonary outpatient clinics. Patients may first seek care for dyspnea in a pulmonary outpatient clinic. Existing data on in-hospital use suggests that integrating lung POCUS into clinic visits may lead to earlier diagnosis and limit the need for additional testing [1,2].

Objective: The aim of this observational study was to evaluate the feasibility, clinical impact, indications, practices, and findings associated with lung POCUS in an urban-based pulmonary outpatient clinic.

Methods: We reviewed 100 consecutive patients who underwent a lung POCUS exam during their pulmonary outpatient clinic visit. Lung POCUS was performed by trainees and faculty, stored in a cloud-based archival system, and reviewed by pulmonary attendings. Findings were categorized into three patterns: predominant A-line, predominant B-lines, and predominant A-lines with a B-line focus. Summary statistics were performed using the data.

Results: The mean age of the included patients was 57+/- 17 years, and 64% were female. Residents performed 70% of the studies. The median time for a lung POCUS exam was 5 minutes. A normal lung POCUS with a predominant bilateral A-line pattern (71%) was most commonly associated with obstructive airway disease (31%). A bilateral B-line pattern (13%) was associated with either interstitial lung disease (7%) or heart failure (8%). Focal dense B-lines (10%) were seen with atelectasis (3%) or other abnormal computed tomography (CT) findings (3%). Lung POCUS demonstrated stability versus progression of pleural effusions in 18% of cases. Of the 49% of patients who had additional imaging ordered for them, there was 100% concordance between lung POCUS findings and chest X-ray (CXR). We explored the potential impact of lung POCUS on clinical management in five cases.

Conclusions: Lung POCUS is feasible to perform in a pulmonary outpatient clinic without adding a significant amount of time to the patient encounter. There is strong concordance between a normal lung POCUS and CXR, which can supplant the need for CXRs in certain conditions. Areas of future research include evaluating providers' attitudes towards lung POCUS use in the clinic setting and integrating lung POCUS into clinic workflow.

In females, failure of the processus vaginalis to close properly can result in continued outpouching of the parietal peritoneum through the inguinal canal into the labia majora, forming a structure known as the Canal of Nuck. In rare cases, a Canal of Nuck hydrocoele can develop in association with the presence of a ventriculoperitoneal (VP) shunt, leading to symptoms of pain and discomfort in the inguinal region. We present the first reported case of a Canal of Nuck hydrocoele identified using POCUS in a child. This case highlights the role of POCUS as a safe, reliable, first-line imaging tool for identifying Canal of Nuck hydrocoeles in patients with VP shunts.