Comparison of transvaginal ultrasound utilization between radiology and point of care ultrasound in first trimester pregnancy.

BACKGROUND: Transvaginal (TVUS) and transabdominal ultrasound (TAUS) are both utilized in the evaluation of early pregnancy patients. While many practitioners using point of care ultrasound (POCUS) will generally not pursue TVUS in cases where an intrauterine pregnancy (IUP) is visualized on TAUS, this may not be true in Radiology performed ultrasound. OBJECTIVES: To evaluate for differences in transvaginal ultrasound (TVUS) utilization between Radiology performed (RP) ultrasound and point of care ultrasound (POCUS) by Emergency Department (ED) physicians in early pregnancy patients. Secondarily, to assess length of stay (LOS) differences and the impact of specialized emergency ultrasound training on TVUS utilization. METHODS: This was a retrospective study at a single academic ED. Study population was all ED patients who underwent first trimester ultrasound during the one year period of March 1, 2021 to February 28, 2022. Variables evaluated were chief complaint, gestational age, LOS, TAUS and TVUS utilization, ultrasound findings, and ultrasound specialty training of the ED physician. RESULTS: There were 133 cases of POCUS ultrasound and 254 cases of RP ultrasound. All cases had TAUS imaging performed. Median LOS for patients when POCUS was utilized was 207 min (IQR 151-294) and 258 min (IQR 208-328) for those only using RP ultrasound, p ≤ 0.001. In the POCUS cohort, 38% (95% CI 30%-46%) received TVUS, while 94% received TVUS in the RP cohort (95% CI 90%-96%), p ≤ 0.001. Patients seen by ED faculty with ultrasound specialty training had TVUS 53% of the time (95% CI 41%-65%), while those seen by other ED faculty had TVUS 79% (95% CI 74%-83%) of the time, p = 0.035. CONCLUSION: POCUS in early pregnancy is associated with a significant reduction in TVUS usage. We suspect that POCUS users elect not to pursue TVUS after an IUP is identified on TAUS, while technicians perform protocol-based TVUS irrespective of TAUS findings. Patients seen by ultrasound trained ED physicians are less likely to receive TVUS.

Incidental Renal Cysts Found by Point-of-Care Ultrasound: A Retrospective Chart Review.

BACKGROUND: Incidental findings are unrelated to a patient's complaint, found on diagnostic imaging, such as point-of-care ultrasound (POCUS). Incidental findings represent potential harms to patients and may lead to increased patient anxiety and health care costs related to downstream testing and surveillance. STUDY OBJECTIVES: In this study, we aimed to calculate the rate of incidental renal cysts found by POCUS. Further, we hoped to describe how emergency physicians relay the findings to patients. Lastly, we hoped to examine if patients suffered harms in the 12 months following identification of an incidental renal cyst. METHODS: From our single-center, academic emergency department (ED), we reviewed renal POCUS images from 1000 consecutive adult ED patients to determine if there was a renal cyst. Next, we performed manual chart review to determine if patients were informed of the incidental renal cyst or suffered any patient harms. RESULTS: We found the prevalence of renal cysts to be 6.5% (95% confidence interval: 4.9%-8.4%). Those with cysts were more likely to be older compared to those without (63 ± 14 vs. 49 ± 15 years of age). Only 8% of patients had evidence that they were informed of their incidental renal cyst. No patients received a biopsy or were diagnosed with renal cell carcinoma or polycystic kidney disease. CONCLUSION: Incidental renal cysts are common and are more likely to be found in older adults. In our study, physicians infrequently informed patients of their incidental finding.

Prehospital use of point-of-care tests by community health workers: a scoping review.

Introduction: Point-of-Care Tests (POCTs) are utilized daily in resource abundant regions, however, are limited in the global south, particularly in the prehospital setting. Few studies exist on the use of non-malarial POCTs by Community Health Workers (CHWs). The purpose of this scoping review is to delineate the current diversity in and breadth of POCTs evaluated in the prehospital setting. Methods: A medical subject heading (MeSH) analysis of known key articles was done by an experienced medical librarian and scoping searches were performed in each database to capture "point of care testing" and "community health workers." This review was guided by the PRISMA Extension for scoping reviews. Results: 2735 publications were returned, 185 were nominated for full-text review, and 110 studies were confirmed to meet study criteria. Majority focused on malaria (74/110; 67%) or HIV (25/110; 23%); 9/110 (8%) described other tests administered. Results from this review demonstrate a broad geographic range with significant heterogeneity in terminology for local CHWs. Conclusion: The use of new POCTs is on the rise and may improve early risk stratification in limited resource settings. Current evidence from decades of malaria POCTs can guide future implementation strategies.

Clinical significance of an elevated on-admission beta-hydroxybutyrate in acutely ill adult patients without diabetes.

OBJECTIVE: To determine the relationship between point-of-care ß-hydroxybutyrate (BHB) concentration and outcomes in adult patients without diabetes admitted through ED. METHODS: This was a prospective study from 10 March to 2 July 2021. Admitted patients without diabetes had capillary BHB sampled in ED. Outcomes of length-of-stay (LOS), composite mortality/ICU admission rates and clinical severity scores (Quick Sepsis Organ Failure Assessment score/National Early Warning Score [qSOFA/NEWS]) were measured. BHB was assessed as a continuous variable and between those with BHB above and equal to 1.0 mmol/L and those below 1.0 mmol/L. RESULTS: A total of 311 patients were included from 2377 admissions. Median length-of-stay was 4.1 days (IQR 2.1-9.8), 18 (5.8%) died and 37 (11.8%) were admitted to ICU. Median BHB was 0.2 mmol/L (IQR 0.1-0.4). Twenty-five patients had BHB ≥1.0 mmol/L and five were >3.0 mmol/L. There was no significant difference in median LOS for patients with BHB ≥1.0 mmol/L compared to non-ketotic patients, 5.3 days (IQR 2.2-7.5) versus 4.1 days, respectively (IQR 2.0-9.8) (P = 0.69). BHB did not correlate with LOS (Spearman ρ = 0.116, 95% confidence interval: 0.006-0.223). qSOFA and NEWS also did not differ between these cohorts. For those 25 patients with BHB ≥1.0 mmol/L, an infective/inflammatory diagnosis was present in 11 (44%), at least 2 days of fasting in 10 (40%) and ethanol intake >40 g within 48 h in 4 (16%). CONCLUSIONS: Routine BHB measurement in patients without diabetes does not add to clinical bedside assessment and use should be limited to when required to confirm a clinical impression.

Comparison between cardiac output values measured by thermodilution and partial carbon dioxide rebreathing in patients with acute lung injury

CONTEXTO: A termodiluição, considerada técnica padrão para medida do débito cardíaco em pacientes graves, não é isenta de riscos relevantes. Faz-se necessário encontrar métodos alternativos não invasivos, automáticos, simples e acurados para monitorar o débito cardíaco à beira do leito. OBJETIVO: Comparar as medidas do débito cardíaco obtido com os métodos termodiluição e reinalação parcial de gás carbônico em pacientes com lesão pulmonar aguda em dois níveis de gravidade (índice de lesão pulmonar - LIS abaixo de 2,5 grupo A; e acima de 2,5, grupo B). TIPO DO ESTUDO: Comparativo, prospectivo, controlado. LOCAL: Unidades de Terapia Intensiva de dois hospitais-escola. MÉTODOS: Vinte pacientes acometidos de insuficiência respiratória aguda (PaO2/FiO2 < 300), sob ventilação pulmonar artificial, nos quais foram realizadas 294 medidas, 164 medidas no grupo A (n = 11) e 130 no grupo B (n = 9),variando de 14 a 15 medidas por paciente, foram estudados. Débito cardíaco foi medido com termodiluição e reinalação parcial de gás carbônico. RESULTADOS: A correlação entre os métodos estudados foi fraca no grupos A (r = 0,52, p < 0,001*) e no B: r = 0,47, p < 0,001*). A aplicação do teste de Bland-Altman permitiu evidenciar a discordância entre os métodos (grupo A: -0,9 ± 2,71 l/min; IC 95% = - 1,14 a -0,48; e grupo B: -1,75 ± 2,05 l/min (IC 95% = -2,11 a -1,4). A comparação dos resultados (testes t para grupos emparelhados e Mann-Whitney) obtidos nos grupos e entre os grupos de estudo revelou diferenças ( p = 0,00*, p < 0,05). DISCUSSAO: Erros em estimar o CaCO2 (conteúdo arterial de CO2) através da ETCO2 (CO2 de final de corrente) e situações de circulação hiperdinâmica associados a espaço morto e/ou shunt possivelmente expliquem nossos resultados. CONCLUSAO: Em pacientes com lesão pulmonar aguda, o débito cardíaco determinado pela reinalação parcial de gás carbônico difere dos valores medidos com termodiluição. Esta diferença se acentua com a maior gravidade da lesão pulmonar.

Anuario estadístico de servicios médicos 1999 / Statistical yearbook of medical services 1999

La Gerencia de Servicios de Salud, consciente de la importancia actual de la información bioestadística en todos sus niveles y con el objetivo y la necesidad de aprovechar al máximo de recursos que dispone la Institución, pone al alcance de todos los profesionales responsables, de la administración de los diferentes servicios de salud, el presente anuario bioestadístico, instrumento que servirá de guía de todas nuestras actividades médicas y fuente de información referencial, para adoptar y tomar decesiones oportunas con argumentos sólidos de diagnóstico estadístico, sin cuya referencia no seria factible concebir una buena administración en una Institución moderna y seria y menos evaluar en forma objetiva el rendimiento con relación a la mejor calidad, al menor costo, es decir con la minimización de los recursos, la magnificación de los resultados y la cuantificación de las metas logradas dentro del régimen de enfermedad, maternidad y riesgos profesionales a corto plazo.