Patient-performed point-of-care ultrasound (POCUS) may be feasible for use in home-based healthcare. We investigated whether novice users can obtain lung ultrasound (LUS) images via self-scanning with similar interpretability and quality as experts. Adult participants with no prior medical or POCUS training, who were capable of viewing PowerPoint slides in their home and who could hold a probe to their chest were recruited. After training, volunteers self-performed 8-zone LUS and saved images using a hand-held POCUS device in their own home. Each 8-zone LUS scan was repeated by POCUS experts. Clips were independently viewed and scored by POCUS experts blinded to performing sonographers. Quality and interpretability scores of novice- and expert-obtained LUS images were compared. Thirty volunteers with average age of 42.8 years (Standard Deviation (SD) 15.8), and average body mass index of 23.7 (SD 3.1) were recruited. Quality of novice and expert scans did not differ (median score 2.6, interquartile range (IQR) 2.3-2.9 vs. 2.8, IQR 2.3-3.0, respectively p = 0.09). Individual zone quality also did not differ (P > 0.05). Interpretability of LUS was similar between expert and novice scanners (median 7 zones interpretable, IQR 6-8, for both groups, p = 0.42). Interpretability of novice-obtained scans did not differ from expert scans (median 7 out of 8 zones, IQR 6-8, p = 0.42). Novice-users can self-obtain interpretable, expert-quality LUS clips with minimal training. Patient-performed LUS may be feasible for outpatient home monitoring.
Publications
2022
INTRODUCTION: Pain scales are often used in peripheral nerve block studies but are problematic due to their subjective nature. Ultrasound-measured diaphragmatic excursion is an easily learned technique that could provide a much-needed objective measure of pain control over time with serial measurements.
CASE SERIES: We describe three cases where diaphragmatic excursion was used as an objective measure of decreased pain and improved respiratory function after serratus anterior plane block in emergency department patients with anterior or lateral rib fractures.
CONCLUSION: Diaphragmatic excursion may be an ideal alternative to pain scores to evaluate serratus anterior plane block efficacy. More data will be needed to determine whether this technique can be applied to other ultrasound-guided nerve blocks.
Ultrasonographic B-lines are artifacts present in alveolar-interstitial syndromes. We prospectively investigated optimal depth, gain, focal position and transducer type for B-line visualization and image quality. B-Lines were assessed at a single rib interspace with curvilinear and linear transducers. Video clips were acquired by changing parameters: depth (6, 12, 18 and 24 cm for curvilinear transducer, 4 and 8 cm for linear transducer), gain (10%, 50% and 90%) and focal position (at the pleural line or half the scanning depth). Clips were scored for B-lines and image quality. Five hundred sixteen clips were obtained and analyzed. The curvilinear transducer improved B-line visualization (63% vs. 37%, p < 0.0001), with higher image quality (3.52 ± 0.71 vs. 3.31 ± 0.86, p = 0.0047) compared with the linear transducer. B-Lines were better visualized at higher gains (curvilinear: gain of 50% vs. 10%, odds ratio = 7.04, 95% confidence interval: 4.03-12.3; gain of 90% vs. 10%, odds ratio = 9.48, 95% confidence interval: 5.28-17.0) and with the focal point at the pleural line (odds ratio = 1.64, 95% confidence interval: 1.02-2.63). Image quality was highest at 50% gain (p = 0.02) but decreased at 90% gain (p < 0.0001) and with the focal point at the pleural line (p < 0.0001). Image quality was highest at depths of 12-18 cm. B-Lines are best visualized using a curvilinear transducer with at least 50% gain and focal position at the pleural line. Gain less than 90% and image depth between 12 and 18 cm improve image quality.
BACKGROUND: Shift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being.
OBJECTIVE: We tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift.
METHODS: Emergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights' sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post-overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls.
RESULTS: In total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights' sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI -0.90 to -0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI -0.81 to -0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores.
CONCLUSIONS: Nonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions' effect on other populations of shift workers' post-night shift alertness, users' long-term physical and mental health, and patient outcomes.
OBJECTIVES: Computed tomography (CT) has long been the gold standard in diagnosing patients with suspected small bowel obstruction (SBO). Recently, point-of-care ultrasound (POCUS) has demonstrated comparable test characteristics to CT imaging for the diagnosis of SBO. Our primary objective was to estimate the annual national cost saving impact of a POCUS-first approach for the evaluation of SBO. Our secondary objectives were to estimate the reduction in radiation exposure and emergency department (ED) length of stay (LOS).
METHODS: We created and ran 1000 trials of a Monte Carlo simulation. The study population included all patients presenting to the ED with abdominal pain who were diagnosed with SBO. Using this simulation, we modeled the national annual cost savings in averted advanced imaging from a POCUS-first approach for SBO. The model assumes that all patients who require surgery or have non-diagnostic POCUS exams undergo CT imaging. The model also conservatively assumes that a subset of patients with diagnostic POCUS exams undergo additional confirmatory CT imaging. We used the same Monte Carlo model to estimate the reduction in radiation exposure and total ED bed hours saved.
RESULTS: A POCUS-first approach for diagnosing SBO was estimated to save a mean (±SD) of $30.1 million (±8.9 million) by avoiding 143,000 (±31,000) CT scans. This resulted in a national cumulative decrease of 507,000 bed hours (±268,000) in ED LOS. The reduction in radiation exposure to patients could potentially prevent 195 (±56) excess annual cancer cases and 98 (±28) excess annual cancer deaths.
CONCLUSIONS: If adopted widely and used consistently, a POCUS-first algorithm for SBO could yield substantial national cost savings by averting advanced imaging, decreasing ED LOS, and reducing unnecessary radiation exposure in patients. Clinical decision tools are needed to better identify which patients would most benefit from CT imaging for SBO in the ED.
Background and objectives Patients infected with influenza and COVID-19 exhibit similar clinical presentations; thus, a point-of-care test to differentiate between the diseases is needed. Here, we sought to identify features of point-of-care lung ultrasound (LUS) that can discriminate between influenza and COVID-19. Methods In this prospective, cross-sectional study, LUS clips of patients presenting to the emergency department (ED) with viral-like symptoms were collected via a 10-zone scanning protocol. Deidentified clips were interpreted by emergency ultrasound fellows blinded to patients' clinical context and influenza or COVID-19 diagnosis. Modified Soldati scores were calculated for each lung zone. Logistic regression identified the association of pulmonary pathologies with each disease. Results Ultrasound fellows reviewed LUS clips from 165 patients, of which 30.9% (51/165) had confirmed influenza, 33.9% (56/165) had confirmed COVID-19, and 35.1% (58/165) had neither disease. Patients with COVID-19 were more likely to have irregular pleura and B-lines in all lung zones (p<0.01). The median-modified Soldati score for influenza patients was 0/20 (IQR 0-2), 9/20 (IQR 2.5-15.5) for COVID-19 patients, and 2/20 (IQR 0-8) for patients with neither disease (p<0.0001). In multivariate regression analysis adjusted for age, sex, and congestive heart failure (CHF), the presence of B-lines (OR = 1.29, 95% CI 1.09-1.53) was independently associated with COVID-19 diagnosis. The presence of pleural effusion was inversely associated with COVID-19 (OR = 0.09, 95% CI 0.01-0.65). Conclusions LUS may help providers preferentially identify the presence of influenza versus COVID-19 infection both visually and by calculating a modified Soldati score. Further studies assessing the utility of LUS in differentiating viral illnesses in patients with variable illness patterns and those with variable illness severity are warranted.