Objectives The aim of this study was to assess the feasibility of quantitative ultrasound imaging (QUI) in assessing the biceps brachii muscle and gastrocnemius muscle in adults with multiple sclerosis (MS). Methods From May to October 2018, we prospectively performed B‐mode ultrasound imaging and ultrasound strain elastography of the biceps brachii muscle and gastrocnemius muscle in 24 patients with MS and 10 age‐matched healthy volunteers. ImageJ (https://imagej.nih.gov/ij) was used to assess the muscle pixel intensity in grayscale images. Using 2‐dimensional speckle‐tracking software, we estimated the muscle axial peak strain (maximum deformation) produced by manual compression with an ultrasound transducer and the muscle longitudinal peak strain (maximum displacement) produced by passive elbow and ankle movements. Muscle QUI parameters used in the study included the mean pixel intensity, axial peak strain ratio (SR = muscle strain/subcutaneous tissue strain), and longitudinal peak SR. Statistical analyses included 1‐way analysis of variance and a post hoc test to examine the differences in QUI parameters among 3 groups (1, affected muscle in patients with MS; 2, unaffected muscle in patients with MS; and 3, healthy muscle in controls) and, in all paired groups, an unpaired t test to compare the muscle SR in patients with MS with a Modified Ashworth Scale (MAS) score of 1 or higher to those with an MAS score of 0. Results The mean age of the 24 patients with MS was 43 years, and all patients and volunteers were female. We observed a significant difference in QUI parameters among the affected muscle in MS, unaffected muscle in MS, and healthy muscle in all paired groups and in patients with MS between an MAS score of 1 or higher and an MAS score of 0 (all P < .05). Interobserver and intraobserver variability in performing QUI was good (intraclass correlation coefficients >0.75). Conclusions Our results suggest that QUI is feasible to assess muscle echogenicity and mechanical behaviors in adult MS.
Musculoskeletal point of care ultrasound (MSKPOCUS) holds potential to greatly improve patient outcomes. In order to develop a rational approach to its use, the clinician needs to be aware of multiple factors that influence its ability to do so. These factors include educational aspects relating to competence, normative data and disease prevalence, definitions of pathology, the influence of technology, validity and reliability, how MSKPOCUS influences patient management, and more importantly, patient outcomes.This presentation looks at the MSK POCUS process and these factors, and using clinical examples, discusses how we can use our findings to develop a rational approach to MSKPOCUS in order to improve patient management and outcomes.
Introduction: Identification of sudden out-of-hospital cardiac arrest (OHCA) and delivery of bystander emergency medical dispatcher (EMD)-directed pre-arrival instructions are key elements in the chain of survival. In order to provide instructions, dispatchers must formulate a clinical impression (rather than a definitive diagnosis) after an abbreviated history and dispatcher-directed examination of the scene. Thus, fast and accurate identification tools are imperative in the treatment of OHCA. Hypothesis: A dispatch-directed breathing verification diagnostic tool (BVDxT) accurately identifies inadequate breathing from OHCA. Methods: A retrospective design using EMD data matched to electronic patient care records (ePCRs) from the Salt Lake City Fire Department. The BVDxT, an embedded interface within the dispatch system, allows dispatchers to count breaths as reported by callers and record the rate of 4 consecutive patient breaths. OHCA was defined as non-trauma cases that had paramedic primary impression of cardiac arrest, respiratory arrest, or overdose or a Glasgow Coma Score of 3. Results: A total of 45,007 emergency dispatch cases were matched with the paramedic impressions of 38,258 ePCRs. Of the matched cases, 2660 cases included some use of the BVDxT, 1,365 (51.3%) had used the BVDxT to completion (i.e. breathing rate was recorded during the call) and, of those, 1,248 (91.4%) had complete on-scene paramedic primary or secondary impressions to match to the BVDxT outcomes. Median time using the tool was 28 seconds (IQR: 21-39). Overall, BVDxT identified 68.6% (n = 856/1,248) callers with disordered breathing and paramedics recorded 16.4% (205/1,248) cases of OHCA. BVDxT demonstrated a 70.7% (145/205) sensitivity, and 31.8% specificity for OHCA. Conclusions: Preliminary evidence suggest the BVDxT does well in predicting abdominal breathing condition. Although, by design, emergency dispatch tools tend to have high sensitivity, the low specificity of the tool may over-triage the number of abnormal breathing issues in the field - which may result in a substantial proportion of possible false positives. Changes in patient condition between call receipt and EMS arrival may also impact these findings.
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