Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France.

OBJECTIVE: Ensuring the availability of ultrasound devices is the initial step in implementing clinical ultrasound (CUS) in emergency services. In France in 2011, 52% of emergency departments (EDs) and only 9% of mobile intensive care stations (MICS) were equipped with ultrasound devices. The main goal of this study was to determine the movement of these rates since 2011. METHODS: We conducted a cross-sectional, descriptive, multicentre study in the form of a questionnaire. To estimate the numbers of EDs and MICS equipped with at least one ultrasound system with a confidence level of 95% and margin of error of 5%, 170 responding EDs and 145 MICS were required. Each service was solicited three times by secure online questionnaire and then by phone. RESULTS: Three hundred and twenty-eight (84%) services responded to the questionnaire: 179 (86%) EDs and 149 (82%) MICS. At least one ultrasound machine was available in 127 (71%, 95% CI [64; 78]) EDs vs. 52% in 2011 (P<0.01). 42 (28%, 95% CI [21; 35]) MICS were equipped vs. 9% in 2011 (P<0.01). In 97 (76%) EDs and 24 (55%) MICS, less than a half of physicians were trained. CUS was used at least three times a day in 52 (41%) EDs and in 8 (19%) MICS. CONCLUSION: Our study demonstrates improved access to ultrasound devices in French EDs and MICS. Almost three-quarters of EDs and nearly one-third of MICS are now equipped with at least one ultrasound device. However, the rate of physicians trained per service remains insufficient.

Diagnostic performance of a low dose triple rule-out CT angiography using SAFIRE in emergency department.

OBJECTIVES: To compare the diagnostic performance of "triple rule out" CT angiography (TRO-CTA) at 100kVp using sinogram affirmed iterative reconstruction (SAFIRE) with TRO-CTA at 120kVp using filtered back projection (FBP) in patients with acute chest pain. METHODS: Consecutive non-prepared patients from a single radiological emergency department, referred for acute chest pain evaluation with TRO-CTA, were randomly assigned to two different TRO-CTA protocols. Fifty patients (66% men; mean age, 66.6±19.0 [SD] years [range: 24-97years]) had TRO-CTA at 120kVp with FBP and 97 patients (67% men; mean age, 62.8±17.9 [SD] years [range: 24-93years]) had TRO-CTA at 100kVp with SAFIRE. Two radiologists reviewed the TRO-CTA images for pathologic findings and degree of diagnostic confidence. Image noise, vessel attenuation value, signal-to-noise and contrast-to-noise ratios in five main thoracic arteries were measured for objective and subjective analysis. RESULTS: A total of 147 patients (98 men, 49 women; mean age, 64.7±18.4 [SD] [range, 24-97years) were included with good diagnostic confidence and equivalent pathological findings between the two TRO-CTA protocols. Objective and subjective analysis were identical between protocols and radiologists, except for vessel attenuation in the ascending aorta (P=0.02) and image noise in the pulmonary trunk (P=0.04). The effective radiation dose decreased significantly by 34% in the low dose TRO-CTA using SAFIRE protocol (5.7±2.7 vs 8.6±6.1mSv; P=4.7×10-6). CONCLUSIONS: Low dose TRO-CTA protocol using SAFIRE allows a high confidence diagnostic level with the benefit of a 34% radiation dose decrease compared with a standard TRO-CTA protocol using FBP.

Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting: a French survey.

INTRODUCTION: The utility of bedside ultrasound (US) performed by emergency physicians has been proven for multiple purposes. There are no data about this technique in emergency departments (ED) in France. The primary objective is to determine the availability of ultrasound device (UD) in EDs and in prehospital settings in France. Minor objectives are to determine the number and type of UD, the most current applications of US and the factors correlated with availability of UDs in the setting of emergency medicine. METHODS: This is a cross-sectional, descriptive, multicenter survey from December 2010 to June 2011, including all EDs and prehospital units in France. A questionnaire was sent by e-mail. Non-responders were contacted by telephone with one recall. RESULTS: The response rate was 74% (327/440) for EDs and 73% (278/379) for prehospital units. A UD is available in 52% (171/327) (CI 95% [46; 58]) of EDs and in 9% (25/278) (CI 95% [5; 13]) of prehospital units. Among departments having no access to UDs, 29% of EDs and 12% of prehospital units have plans to implement emergency physician-performed US. The most common US applications are focused assessment with sonography for trauma and pleural exams. CONCLUSION: Availability of UDs in French public hospital EDs is 52% and 9% in prehospital units. Despite the progressive expansion of the technique over the last years, bedside ultrasonography is not yet completely integrated in the physical examination of the patient in an emergency situation in France. A reassessment will be required to confirm the current trend of expansion.