Publications

BACKGROUND: This study aimed to demonstrate the feasibility of using computer vision (CV) to unobtrusively extract body motion metrics from videos of emergency medicine (EM) clinicians, and gather validity evidence of these metrics to differentiate POCUS skills between novice and experts, as well as to capture skills gained over time.

METHODS: Prospective cohort study including novice and expert EM clinicians performing echocardiogram (ECHO) and focused assessment with sonography for trauma (FAST) exams on a live simulated patient. Expert observers provided objective structured clinical examination (OSCE) scores (numerical ratings on a scale from 1 to 100), and sonographers' hands and head motion metrics (path length, speed, acceleration, jerk, and smoothness) were extracted via CV using 2-dimensional videos. Data points were captured at baseline, and for novices at baseline and after 12-15 months of residency training.

RESULTS: CV achieved high detection rates (99.52% ECHO, 98.70% FAST). At baseline, experts demonstrated superior OSCE scores (ECHO: 98.6 ± 2.1 vs 63.4 ± 17.0; FAST: 99.2 ± 1.5 vs 68.9 ± 17.7, p < 0.001) and faster task completion (101.8 ± 44.7 vs 240.3 ± 84.1 s, p < 0.001). Experts exhibited smoother hand movements (left hand smoothness: -129.3 ± 47.6 vs -241.3 ± 64.6, p < 0.001) and reduced total path lengths. After 12-15 months of training, novices showed significant improvements in OSCE scores (ECHO: 85.3 ± 10.3; FAST: 84.8 ± 6.5) and task efficiency (134.0 ± 35.6 s), with improvements in motion smoothness and reduced path lengths (p < 0.001). Motion metrics strongly correlated with OSCE scores (r = 0.455-0.783) and task completion time (r = 0.491-0.951).

CONCLUSIONS: CV successfully extracted objective motion metrics that differentiated POCUS skill levels between novices and experts and captured skill development over time. This approach offers a scalable, unobtrusive method for objective POCUS assessment, while supporting competency-based medical education frameworks.

OBJECTIVE: The objective of this study was to evaluate the impact of operator training level, specifically comparing Emergency Medicine (EM) attending physicians and residents, on the analgesic efficacy of ultrasound-guided nerve blocks (UGNBs) performed in the emergency department (ED).

METHODS: This is a secondary analysis of the National Ultrasound-Guided Nerve (NURVE) Block Registry, involving 11 U.S. EDs from January 1, 2022, to December 31, 2023. Adult patients undergoing UGNBs for acute pain or procedural analgesia were included, totaling 1595 procedures after exclusion of incomplete post-procedural pain scores. The primary outcome was percent pain reduction, with >50% defined as clinically meaningful and > 75% as substantial analgesia. Subgroup analyses were performed by operator experience and block type.

RESULTS: Attendings achieved clinically meaningful pain reduction in 80.7% of cases versus 63.4% for residents, and substantial reduction in 68.1% vs 47.7% respectively (p < 0.001). This difference persisted at the highest experience level (>20 prior blocks: 82.3% vs 71.0%, p = 0.0007) and was observed across block types, reaching significance for erector spinae plane blocks (79.6% vs 63.6%, p = 0.01). Complications were rare (0.13%), with both events in resident-performed blocks.

CONCLUSION: UGNBs performed by attendings were associated with greater analgesic success compared with those by residents, yet both groups achieved high rates of clinically meaningful pain reduction with very low complication rates. These results underscore the role of experience in UGNB efficacy while supporting the safety and effectiveness of supervised resident performance in the ED.

BACKGROUND: Ultrasound-guided nerve blocks (UGNBs) are increasingly incorporated into multi-modal analgesia in the Emergency Department (ED). Despite their growing adoption, there is no consensus defining when an Emergency Medicine (EM) clinician is competent to perform UGNBs. Training methods, assessment approaches, and credentialing standards remain highly variable across institutions. The objective of this study was to define competency in UGNBs for EM physicians through a modified Delphi method that included national experts in EM and Anesthesia.

METHODS: A comprehensive librarian-assisted literature review informed the development of a 123-item questionnaire covering four domains: defining competency, teaching methods, assessment methods, and ongoing professional practice evaluation. Twenty-seven experts (23 EM, 4 anesthesiology) representing 24 institutions participated in two rounds of electronic voting and discussion. Consensus was defined a priori as 80% agreement.

RESULTS: All 27 panelists (100%) completed both rounds. Of 123 items, 61 achieved consensus: 33 items related to defining competency, 14 to teaching methods, 8 to assessment methods, and 6 to ongoing professional practice evaluation related to UGNBs. There was significant debate regarding the minimum number of UGNBs to determine competency and whether UGNBs should be included as a core ultrasound privilege.

CONCLUSION: This multidisciplinary modified Delphi provides the first national consensus defining competency in UGNBs for both practicing and EM physicians in training. The 61 consensus items offer a structured framework for residency curricula, faculty development, clinical privileging, and quality assurance. These recommendations may help guide forthcoming ACGME requirements and support safe, effective integration of UGNBs into emergency medicine training.

Ultrasound-guided nerve blocks (USGNBs) are increasingly used in the emergency department (ED) as a safe and effective part of multimodal pain management. Their use has been shown to reduce reliance on opioids and procedural sedation, improve pain scores, and enhance functional outcomes for patients. Additionally, USGNBs in the ED have a complication rate of 0.4%, markedly lower than procedural sedation (4-11%), and they significantly reduce opioid requirements, which is critical considering the current opioid epidemic and the risks of persistent opioid use and overdose. Despite these benefits, relevant concerns about medicolegal liability, informed consent, evolving standards of care, may still influence the adoption of USGNBs in clinical practice. To address these issues, this review examines the legal risks associated with USGNBs by drawing on current clinical literature, closed claims data, and case law. We highlight common adverse events such as peripheral nerve injury and local anesthetic systemic toxicity and assess their legal implications. Potential legal risk including liability related to alternatives like opioid use and procedural sedation, are discussed. While the risk of litigation remains low when best practices are followed, failing to offer a USGNB when clearly indicated may increasingly be viewed as a liability if preventable complications occur. This article aims to provide a practical, interdisciplinary framework, including legal risk assessment, training, credentialing, and risk mitigation, to help clinicians, educators, and hospital administrators safely and confidently integrate USGNBs into ED practice.

When given a sample of 100 emergency department discharge instructions, Claude Sonnet, a large language model, produced accurate Spanish translations as evaluated by Spanish-speaking physicians and medical interpreters.