Ultrasound applications in mass casualties and extreme environments

John, Oommen; Norvell, Jeffrey; Subramanian, S. V.

doi:10.1097/01.ccm.0000260677.29207.b4

Cited by 105 publications

(31 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The advantage of ultrasonography over other imaging modalities is that it can be performed at the point of care, without exposing children to the greater cancer risks of ionizing radiation relative to adults. 33 It is feasible and less costly to implement ultrasonography in remote regions 34,35 or underserved areas and developing countries [36][37][38][39] compared with radiography. [37][38][39] These features and the high accuracy rate demonstrated in this and other studies [13][14][15] make ultrasonography a promising alternative that has the potential to rapidly diagnose pneumonia at the point of care and to improve outcomes.…”

Section: Clinical Examinationmentioning

confidence: 99%

Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

Shah¹,

Tunik²,

Tsung³

2013

JAMA Pediatr

265

284

View full text Add to dashboard Cite

Section: Clinical Examinationmentioning

confidence: 99%

Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

Shah¹,

Tunik²,

Tsung³

2013

JAMA Pediatr

265

284

View full text Add to dashboard Cite

“…30 In addition, ultrasound may be useful for triage in mass casualty disasters 31 or in austere environments. 32 Last, ultrasound may be used in pediatricians'offices or in urgent care centers for patients with suspected isolated skull fracture without ready access to CT scan.…”

Section: Figurementioning

confidence: 99%

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

et al. 2013

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Head injuries and concern for skull fracture are common in pediatrics. Point-of-care ultrasound is an imaging tool that can be used to diagnose fractures. However, there are scant data regarding the accuracy of point-ofcare ultrasound in skull fracture diagnosis. WHAT THIS STUDY ADDS:Clinicians with focused point-of-care ultrasound training are able to diagnose skull fractures in children with high specificity. Ultrasound may be valuable to diagnose skull fractures in children at the point of care. abstract OBJECTIVE: To determine the test performance characteristics for point-of-care ultrasound performed by clinicians compared with computed tomography (CT) diagnosis of skull fractures. METHODS:We conducted a prospective study in a convenience sample of patients #21 years of age who presented to the emergency department with head injuries or suspected skull fractures that required CT scan evaluation. After a 1-hour, focused ultrasound training session, clinicians performed ultrasound examinations to evaluate patients for skull fractures. CT scan interpretations by attending radiologists were the reference standard for this study. Pointof-care ultrasound scans were reviewed by an experienced sonologist to evaluate interobserver agreement.RESULTS: Point-of-care ultrasound was performed by 17 clinicians in 69 subjects with suspected skull fractures. The patients' mean age was 6.4 years (SD: 6.2 years), and 65% of patients were male. The prevalence of fracture was 12% (n = 8). Point-of-care ultrasound for skull fracture had a sensitivity of 88% (95% confidence interval [CI]: 53%-98%), a specificity of 97% (95% CI: 89%-99%), a positive likelihood ratio of 27 (95% CI: 7-107), and a negative likelihood ratio of 0.13 (95% CI: 0.02-0.81). The only false-negative ultrasound scan was due to a skull fracture not directly under a scalp hematoma, but rather adjacent to it. The k for interobserver agreement was 0.86 (95% CI: 0.67-1.0). CONCLUSIONS:Clinicians with focused ultrasound training were able to diagnose skull fractures in children with high specificity. Pediatrics

show abstract

“…Bedside US also provides clinically useful information in settings outside of the traditional hospital, including military combat zones, 18 disaster areas, 19 and developing countries. 20 Although not traditional medical settings, it is important to have knowledge of how to use bedside US to assist in decision-making, such as evacuation protocols or prioritization of treatment.…”

mentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Joshi

Lira

Mehta

et al. 2013

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Understanding history, physical examination, and ultrasonography (US) to diagnose extremity fractures compared with radiography has potential benefits of decreasing radiation exposure, costs, and pain and improving emergency department (ED) resource management and triage time. Methods:The authors performed two electronic searches using PubMed and EMBASE databases for studies published between 1965 to 2012 using a strategy based on the inclusion of any patient presenting with extremity injuries suspicious for fracture who had history and physical examination and a separate search for US performed by an emergency physician (EP) with subsequent radiography. The primary outcome was operating characteristics of ED history, physical examination, and US in diagnosing radiologically proven extremity fractures. The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS-2).Results: Nine studies met the inclusion criteria for history and physical examination, while eight studies met the inclusion criteria for US. There was significant heterogeneity in the studies that prevented data pooling. Data were organized into subgroups based on anatomic fracture locations, but heterogeneity within the subgroups also prevented data pooling. The prevalence of fracture varied among the studies from 22% to 70%. Upper extremity physical examination tests have positive likelihood ratios (LRs) ranging from 1.2 to infinity and negative LRs ranging from 0 to 0.8. US sensitivities varied between 85% and 100%, specificities varied between 73% and 100%, positive LRs varied between 3.2 and 56.1, and negative LRs varied between 0 and 0.2. Conclusions:Compared with radiography, EP US is an accurate diagnostic test to rule in or rule out extremity fractures. The diagnostic accuracy for history and physical examination are inconclusive. Future research is needed to understand the accuracy of ED US when combined with history and physical examination for upper and lower extremity fractures.ACADEMIC EMERGENCY MEDICINE 2013; 20:1-15 © 2013 by the Society for Academic Emergency Medicine E xtremity injuries are among the most frequent reasons for visiting the emergency department (ED). These injuries are significant, comprising over 42.4 million injury-related visits to the ED in 2006. 1The typical work-up of the injured patient generally involves a medical provider obtaining a history and physical examination, often followed by radiologic imaging. However, many times the radiologic imaging may be negative or inconclusive, which calls to question whether the imaging contributed to the management or outcome of the patient. Studies have shown that often the imaging obtained is unnecessary and results in radiation exposure to patients and increased ED wait times. 2There is a low rate of positive radiography when assessing for fractures as evidenced by a retrospective review by Bentohami et al.,3 in which only 50% of upper extremity x-rays showed fractures, and another ...

show abstract

Ultrasound applications in mass casualties and extreme environments

Cited by 105 publications

References 28 publications

Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Contact Info

Product

Resources

About