The effect of display size on ultrasound interpretation.

OBJECTIVES: Ultrasound (US) is an essential component of emergency department patient care. US machines have become smaller and more affordable. Handheld ultrasound (HUS) machines are even more portable and easy to use at the patient's bedside. However, miniaturization may come with consequences. The ability to accurately interpret ultrasound on a smaller screen is unknown. This pilot study aims to assess how screen size affects the ability of emergency medicine clinicians to accurately interpret US videos. METHODS: This pilot study enrolled a prospective convenience sample of emergency medicine physicians. Participants completed a survey and were randomized to interpret US videos starting with either a phone-sized screen or a laptop-sized screen, switching to the other device at the halfway point. 50 unique US videos depicting right upper quadrant (RUQ) views of the Focused Assessment with Sonography in Trauma (FAST) examination were chosen for inclusion in the study. There were 25 US videos per device. All of the images were previously obtained on a cart-based machine (Mindray M9) and preselected by the study authors. Participants answered "Yes" or "No" in response to whether they identified free fluid. The time that each participant took to interpret each video was also recorded. Following the assessment, participants completed a post-interpretation survey. The goal of the pilot was to determine the accuracy of image interpretation on a small screen as compared to a laptop-sized screen. Statistical analyses were performed using MATLAB (The MathWorks, Inc., Natick, MA). Nonparametric statistical tests were utilized to compare subgroups, with a Wilcoxon signed rank test used for paired data and a Wilcoxon rank sum test for unpaired data. RESULTS: 52 emergency medicine physicians were enrolled in the study. The median accuracy of US interpretation for phone versus laptop image screen was 88.0% and 87.6% (p = 0.67). The mean time to interpret with phone versus laptop screen was 293 and 290 s (p = 0.66). CONCLUSIONS: The study found no statistically significant difference in the accuracy of US interpretation nor time spent interpreting when the pre-selected RUQ videos generated on a cart-based ultrasound machine were reviewed on a phone-sized versus a laptop-sized screen. This pilot study suggests that the accuracy of US interpretation may not be dependent upon the size of the screen utilized.

Special Article - The role of hand-held ultrasound for cardiopulmonary assessment during a pandemic.

During the COVID-19 pandemic, we are likely to see a significant increase in the requests for rapid assessment of cardiac function, due to the frequent pre-existence of cardiac pathologies in patients admitted to hospital, and to the emergence of specific cardiac manifestations of this infection, such as myocarditis, sepsis related cardiomyopathy, stress induced cardiomyopathy and acute coronary syndromes. Hand-held, point-of-care ultrasound (HH-POCUS) is particularly suited for the provision of rapid, focused, integrated assessments of the heart and lungs. We present a review of the indications and protocols for focused HH-POCUS use in an acute setting and formulate proposals for streamlining their application in the COVID-19 context towards guiding optimum management of these patients while at the same time allowing adherence to robust infection control measures to provide safety to both the patient and our clinical staff.

Focused Assessment with Sonography in Trauma for Assessment of Injury in Military Settings: A Meta-analysis

Background: Non-invasive, rapid, and precise assessment of injury in the military settings is extremely important, yet difficult. Focused assessment with sonography in trauma (FAST) is being increasingly employed for assessing the location and severity of injury and guiding further treatment strategy. However, the evidence regarding the utility of FAST in the military settings is scattered. Aims: To evaluate the diagnostic performance of FAST in the assessment of injury in the military settings. Study Design: Meta-analysis. Methods: We identified all relevant papers via the PubMed, EMBASE, and Cochrane Library databases. We evaluated the quality of included studies by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We pooled the area under the curve (AUC), sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio as the effect sizes, followed by evaluating the heterogeneity among the studies by p value and I2. Results: Among the 39 papers, a total of six papers were included. The sample size ranged from 15 to 396. The AUC of FAST for assessing the injury was 0.85. The pooled sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were 0.66, 0.98, 33.1, 0.34, and 97, respectively. The heterogeneity among the studies was statistically significant (p=0.006, I2=78%). Conclusion: FAST is potentially valuable for assessing injury in the military settings. Due to its high specificity, FAST may be appropriate to rule in significant injury. However, because of its poor sensitivity, the ability of FAST to rule out injury cannot be relied upon.

Diagnostic point-of-care ultrasound: assessment techniques for the pediatric trauma patient

Emergency ultrasound is performed at the point of care to quickly answer focused clinical questions. Over the last 25 years, the use of this technique has expanded rapidly. The use of emergency ultrasound in the pediatric setting is increasing because it does not expose the patient to ionizing radiation, as compared to computed tomography. Utilizing diagnostic point-of-care ultrasound for pediatric trauma patients in the emergency department can facilitate diagnosis at the bedside rather than sending the patient out of the department for another study. This supplement focuses on some of the common indications for diagnostic POCUS that may be useful in the setting of trauma, as found in the pediatric literature, or extrapolated from adult literature where pediatric evidence is scarce.

Focused Cardiac Ultrasonography.

Focused cardiac ultrasonography (FCU) is the use of ultrasonography as an adjunct to physical examination at the point of care. There are ample data supporting the fact that noncardiology trained users using small ultrasonography devices can assess left ventricular (LV) enlargement, LV systolic dysfunction, right ventricular (RV) enlargement, left atrial (LA) enlargement, LV hypertrophy, pericardial effusion, and right atrial (RA) pressure elevation more accurately than performing a physical examination. In addition, FCU-trained providers may have skills to perform ultrasonography imaging of body systems outside the heart to supplement their cardiac evaluation. FCU training, including didactic education, proctored imaging, independent imaging, and image interpretation, has been established by several specialties and medical schools. Cardiologists should embrace FCU in their facilities, as the clinical value to patient care is clear. Cardiologists have the responsibility to maintain excellence in the practice of echocardiography while enabling the use of ultrasonography by other medical professionals to augment their clinical assessments conventionally based on physical examination alone.