Is Point-of-Care Ultrasound Accurate and Useful in the Hands of Military Medical Technicians? A Review of the Literature

Hile, David C.; Morgan, A. R.; Laselle, Brooks; Bothwell, Jason

doi:10.7205/milmed-d-12-00020

Cited by 21 publications

(9 citation statements)

References 19 publications

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“…As an evolving component of medicine, point of care ultrasound (POCUS) spans across multiple specialties and applications, such as military medical personnel, trauma evaluation, pediatric emergency departments and neonatal intensive care units, and even expanding its utility to aerospace science [1][2][3][4][5][6][7][8]. Recent studies have described POCUS as being easily taught to medical personnel with a high degree of accuracy [1,9,10].…”

Section: Introductionmentioning

confidence: 99%

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

et al. 2014

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Background Point of care ultrasound (POCUS) is a useful diagnostic tool in medicine. POCUS provides an easy and reproducible method of diagnosis where conventional radiologic studies are unavailable. Telemedicine is also a great means of communication between educators and students throughout the world. Hypothesis Implementing POCUS with didactics and hands-on training, using portable ultrasound devices followed by telecommunication training, will impact the differential diagnosis and patient management in a rural community outside the United States. Materials and methods This is an observational prospective study implementing POCUS in Las Salinas, a small village in rural western Nicaragua. Ultrasound was used to confirm a diagnosis based on clinical exam, or uncover a new, previously unknown diagnosis. The primary endpoint was a change in patient management. International sonographic instructors conducted didactic and practical training of local practitioners in POCUS, subsequently followed by remote guidance and telecommunication for 3 months. Results A total of 132 patients underwent ultrasound examination. The most common presentation was for a prenatal exam (23.5 %), followed by abdominal pain (17 %). Of the 132 patients, 69 (52 %) were found to have a new diagnosis. Excluding pregnancy, 67 patients of 101 (66 %) were found to have a new diagnosis. A change in management occurred in a total of 64 (48 %) patients, and 62 (61 %) after excluding pregnancy. Conclusion Implementing POCUS in rural Nicaragua led to a change in management in about half of the patients examined. With the appropriate training of clinicians, POCUS combined with telemedicine can positively impact patient care.Keywords Point of care ultrasound Á Rural medicine Á Telemedicine Sommario Background La diagnostica ecografica (POCUS) é un utile strumento diagnostico in medicina. Fornisce un metodo semplice e riproducibile di diagnosi, dove studi radiologici convenzionali non siano disponibili. Anche la telemedicina é un grande mezzo di comunicazione tra docenti e studenti di tutto il mondo. Ipotesi L'implementazione della POCUS con formazione didattica diretta, utilizzando ecografi portatili, seguita da una formazione attraverso la telecomunicazione, avrà un impatto nella diagnosi differenziale e nella gestione del paziente in una comunità rurale fuori degli Stati Uniti. Materiali e Metodi Presentiamo uno studio prospettico sull'implementazione della POCUS a Las Salinas, un piccolo villaggio rurale del Nicaragua occidentale. L'ecografia è stata utilizzata per confermare la diagnosi clinica, o per nuove diagnosi. Il punto primario era un cambiamento nella gestione del paziente. Istruttori internazionali hanno condotto una formazione didattica pratica locale, poi seguita da una guida a distanza con telecomunicazione, per tre mesi. Risultati Un totale di 132 pazienti sono stati sottoposti ad esame ecografico. L'esame più comune era per la diagnostica prenatale (23,5 %), seguito dal dolore addominale (17 %). Dei 132 pazienti, 69 (52 %) h...

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Section: Introductionmentioning

confidence: 99%

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

et al. 2014

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“…Use of ultrasound has been fielded by medics and by other en route team members in the past. Several studies have supported the use of ultrasound by prehospital medics and non-clinical service members with minimal training [ 21 – 24 ]. In addition, ultrasound devices that are aided or have artificial intelligence such as the Butterfly [ 25 ] remove the learning curve for medics and provide results for clinical decision making.…”

Section: Discussionmentioning

confidence: 99%

Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study

et al. 2018

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BackgroundIn combat operations, patients with traumatic injuries require expeditious evacuation to improve survival. Studies have shown that long transport times are associated with increased morbidity and mortality. Limited data exist on the influence of transport time on patient outcomes with specific injury types. The objective of this study was to determine the impact of the duration of time from the initial request for medical evacuation to arrival at a medical treatment facility on morbidity and mortality in casualties with traumatic extremity amputation and non-compressible torso injury (NCTI).MethodsWe completed a retrospective review of MEDEVAC patient care records for United States military personnel who sustained traumatic amputations and NCTI during Operation Enduring Freedom between January 2011 and March 2014. We grouped patients as traumatic amputation and NCTI (AMP+NCTI), traumatic amputation only (AMP), and neither AMP nor NCTI (Non-AMP/NCTI). Analysis was performed using chi-squared tests, Fisher’s exact tests, Cochran-Armitage Trend tests, Shapiro-Wilks tests, Wilcoxon and Kruskal-Wallis techniques and Cox proportional hazards regression modeling.ResultsWe reviewed 1267 records, of which 669 had an injury severity score (ISS) of 10 or greater and were included in the analysis. In the study population, 15.5% sustained only amputation injuries (n=104, AMP only), 10.8% sustained amputation and NCTI (n=72, AMP+NCTI), and 73.7% did not sustain either an amputation or an NCTI (n=493, Non-AMP/NCTI). AMP+NCTI had the highest mortality (16.7%) with transport time greater than 60 min. While the AMP+NCTI group had decreasing survival with longer transport times, AMP and Non-AMP/NCTI did not exhibit the same trend.ConclusionsA decreased transport time from the point of injury to a medical treatment facility was associated with decreased mortality in patients who suffered a combination of amputation injury and NCTI. No significant association between transport time and outcomes was found in patients who did not sustain NCTI. Priority for rapid evacuation of combat casualties should be given to those with NCTI.Electronic supplementary materialThe online version of this article (10.1186/s40779-018-0169-2) contains supplementary material, which is available to authorized users.

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“…Given the serious environment in which the military may be required to treat patients, portable ultrasound lends itself well to triage and diagnosis of multiple medical conditions when more advanced imaging is not available, or when repeat measurements may be of value in an ICU setting. There has been prior research evaluating the training regarding point-of-care ultrasound by military providers [23]. Prior military and combat training with point-of-care ultrasound regarding focused abdominal sonography in trauma (FAST), cardiac activity, pneumothorax, and fractures has been studied [24–26].…”

Section: Discussionmentioning

confidence: 99%

Military trainees can accurately measure optic nerve sheath diameter after a brief training session

et al. 2018

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BackgroundIdentification of elevated intracranial pressure is important following traumatic brain injury. We assessed the feasibility of educating military trainees on accurately obtaining optic nerve sheath diameter measurements using a brief didactic and hands-on training session. Optic nerve sheath diameter is a noninvasive surrogate marker for elevated intracranial pressure, and may be of value in remote military operations, where rapid triage decisions must be made without access to advanced medical equipment.MethodsMilitary trainees with minimal ultrasound experience were given a 5-min didactic presentation on optic nerve sheath diameter ultrasound. Trainees practiced optic nerve sheath diameter measurements guided by emergency physician ultrasound experts. Trainees then measured the optic nerve sheath diameter on normal volunteers. Following this, a trained physician measured the optic nerve sheath diameter on the same volunteer as a criterion standard. An average of three measurements was taken.ResultsTwenty-three military trainees were enrolled. A mixed design ANOVA was used to compare measurements by trainees to those of physicians, with a mean difference of − 0.6 mm (P = 0.76). A Bland-Altman analysis showed that the degree of bias in optic nerve sheath diameter measures provided by trainees was very small: d = − 0.004 for the right eye and d = − 0.007 for the left eye.ConclusionThis study demonstrates that optic nerve sheath diameter measurement can be accurately performed by novice ultrasonographers after a brief training session. If validated, point-of-care optic nerve sheath diameter measurement could impact the triage of injured patients in remote areas.

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Is Point-of-Care Ultrasound Accurate and Useful in the Hands of Military Medical Technicians? A Review of the Literature

Cited by 21 publications

References 19 publications

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study

Military trainees can accurately measure optic nerve sheath diameter after a brief training session

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