A quality assessment tool for focused abdominal sonography for trauma examinations using artificial intelligence.

BACKGROUND: Current tools to review focused abdominal sonography for trauma (FAST) images for quality have poorly defined grading criteria or are developed to grade the skills of the sonographer and not the examination. The purpose of this study is to establish a grading system with substantial agreement among coders, thereby enabling the development of an automated assessment tool for FAST examinations using artificial intelligence (AI). METHODS: Five coders labeled a set of FAST clips. Each coder was responsible for a different subset of clips (10% of the clips were labeled in triplicate to evaluate intercoder reliability). The clips were labeled with a quality score from 1 (lowest quality) to 5 (highest quality). Clips of 3 or greater were considered passing. An AI training model was developed to score the quality of the FAST examination. The clips were split into a training set, a validation set, and a test set. The predicted scores were rounded to the nearest quality level to distinguish passing from failing clips. RESULTS: A total of 1,514 qualified clips (1,399 passing and 115 failing clips) were evaluated in the final data set. This final data set had a 94% agreement between pairs of coders on the pass/fail prediction, and the set had a Krippendorff α of 66%. The decision threshold can be tuned to achieve the desired tradeoff between precision and sensitivity. Without using the AI model, a reviewer would, on average, examine roughly 25 clips for every 1 failing clip identified. In contrast, using our model with a decision threshold of 0.015, a reviewer would examine roughly five clips for every one failing clip - a fivefold reduction in clips reviewed while still correctly identifying 85% of passing clips. CONCLUSION: Integration of AI holds significant promise in improving the accurate evaluation of FAST images while simultaneously alleviating the workload burden on expert physicians. LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level II.

Limb threatening thigh hematoma diagnosis accelerated by emergency physician bedside ultrasound.

INTRODUCTION: Compartment syndrome is a serious condition that requires prompt diagnosis, specialty consultation, and definitive management to prevent significant morbidity. Traditionally, compartment syndrome is identified by physical exam findings including the presence of pain, pallor, paresthesia, pulselessness, and paralysis involving the affected limb. Identifying the presence of compartment syndrome prior to the onset of signs that portend a poor outcome (i.e. pallor, pulselessness, and paralysis) can be challenging since many other less serious traumatic conditions can lead to paresthesia and pain in a limb. Bedside ultrasound is increasingly being utilized by emergency providers to expedite identification of various emergent diagnoses and guide care for patients who present to emergency departments. Bedside ultrasound allows emergency providers to visualize pathologic processes occurring that may be difficult to identify through traditional physical exam findings. This case report highlights the use of bedside ultrasound to promptly identify the presence of a traumatic thigh hematoma, which led to expedited advanced imaging and specialty consultation for compartment syndrome prior to the onset of physical exam findings consistent with compartment syndrome. CONCLUSION: The identification of compartment syndrome in the early stages is challenging given the overlap of signs and symptoms with other less emergent conditions. Early diagnosis of compartment syndrome is important to decrease morbidity, which can result from a delayed diagnosis of compartment syndrome. To our knowledge, this is the first case report to describe the use of bedside ultrasound to aid in the diagnosis of compartment syndrome and accelerate the care for a patient who presented with a traumatic thigh hematoma, which rapidly progressed to compartment syndrome and required emergent operative intervention.

Ten Strategies for Optimizing Ultrasound Instruction for Group Learning.

Ultrasound use is rapidly increasing in clinical care and as an educational modality. While there is widespread interest in training health-care professionals to incorporate ultrasound into their daily practice, there are few resources available to guide instructors in the design of impactful and efficient training sessions. We present 10 practical strategies to optimize the educational value of ultrasound workshops for any audience.

Interactive format is favoured in case conference.

BACKGROUND: Follow-up case presentation (FCP), a staple of emergency medicine residency conference curricula nationwide, has traditionally been delivered using PowerPoint(TM) (PP). The sole use of the PP lecture format may limit audience participation. In light of existing literature supporting chalkboard and morning report formats, we changed FCP to an interactive chalkboard format with limited PP slides. We hypothesised that this change will enhance the perceived educational impact of FCP on learners. METHODS: To examine learners' perceptions regarding the PP-based and 'chalkboard talk' discussion formats, we conducted a time-series investigation with pre- and post-intervention questionnaires using the five-point Likert scale. After obtaining Institutional Review Board exemption, 60 emergency medicine residents (post graduate years 1-4) were recruited through e-mail to complete the pre-intervention questionnaire. The post-intervention questionnaire was administered following a run-in period of nine post-intervention FCPs. The questionnaires were compared using Mantel-Haenszel chi-square tests. RESULTS: The pre- and post-intervention questionnaire completion rates were 83.3 per cent (50/60) and 65 per cent (39/60), respectively. The chalkboard format was perceived by learners to be significantly more effective than PP-based FCPs at educating the learner regarding the topics covered (3.5 versus 4.0, pre- versus post-, respectively, p = 0.003), teaching practical knowledge (3.4 versus 3.8, p = 0.014), stimulating self-knowledge assessment (3.4 versus 3.8, p = 0.023), encouraging the generation of broad differential diagnoses (3.4 versus 3.9, p = 0.008), and promoting an interactive learning environment (3.1 versus 4.1, p < 0.0001). CONCLUSIONS: The implementation of chalkboard format with interactive discussion is perceived by learners to be the superior didactic educational medium, compared with the exclusive use of PP slides for FCPs. The chalkboard format was perceived by learners to be significantly more effective.

Pulmonary ultrasound examination for edema, effusion, and thromboembolism.

Bedside, or point-of-care, ultrasound (US) has increasingly been used in various clinical settings to provide clinicians with rapid clinical information without the use of ionizing radiation. Lung US has been demonstrated as a valuable tool in the diagnosis and evaluation of pulmonary edema, pleural effusions, and pulmonary thromboembolism. Lung US enables the clinician to more quickly identify and initiate treatment for these potentially life-threatening conditions without the need for patient transportation to the radiology suite. Additionally, lung US can repeatedly be implemented to assess clinical changes without concern for repeated radiation exposure and is cost-effective given its ability to decrease the need for additional radiological and laboratory testing to confirm a suspected diagnosis. This review focuses on the application of lung US in the evaluation and management of pulmonary edema, pleural effusions, and pulmonary thromboembolism.