Is it time to re-think FAST? A systematic review and meta-analysis of Contrast-Enhanced Ultrasound (CEUS) and conventional ultrasound for initial assessment of abdominal trauma.

BACKGROUND: The Focused Assessment with Sonography for Trauma (FAST) examination using conventional ultrasound has limited utility for detecting solid organ injury. Therefore, this systematic review and meta-analysis compares the performance of contrast-enhanced ultrasound (CEUS) to conventional ultrasound when used as the initial assessment for abdominal trauma prior to computed tomography (CT) imaging. METHODS: A systematic literature search of major databases was conducted of human studies investigating the diagnostic accuracy of conventional ultrasound and CEUS occurring prior to CT imaging for abdominal trauma. The study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The quality of studies was evaluated using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool. Paired pooled sensitivity and specificity between conventional ultrasound and CEUS were compared using data extracted from the eligible studies. Diagnostic odds ratio, number needed to diagnose values, and likelihood ratios were also determined. RESULTS: Ten studies were included. More than half of the included studies demonstrated low risk of bias. Using McNemar's test to assess for paired binary observations, we found that CEUS had statistically higher sensitivity (0.933 vs. 0.559; two-tailed, P < 0.001) and specificity (0.995 vs. 0.979; two-tailed, P < 0.001) than conventional ultrasound in the setting of abdominal trauma, respectively. When divided into particular findings of clinical interest, CEUS had statistically higher sensitivity than conventional ultrasound in screening for active bleeding and injuries to all abdominal solid organs. CEUS also had superior diagnostic odds ratios, number needed to diagnose values, and likelihood ratios than conventional ultrasound. CONCLUSION: The diagnostic value of CEUS was higher than that of conventional ultrasound for differentiating traumatic abdominal injuries when used as the initial assessment in the emergency department.

A Novel, Reusable, Ultrasound-Guided Pericardiocentesis Simulation Model.

Given the rarity of emergency pericardiocentesis, deliberate effort must be made by the physician to maintain competence in performing this procedure. Herein we describe the construction of a low-cost, reusable, high-fidelity simulation model for ultrasound-guided pericardiocentesis. Sixteen emergency medicine residents participated in a procedure lab using the model and then evaluated the model's efficacy using a survey. Results of this survey found that most participants believed that the model was easy to use and that it increased their competency. There was also a significant increase in self-reported Likert-rated confidence in performing pericardiocentesis before and after simulation (1.63 to 3.81; P < .001).

Residency Leadership Lessons From the Epicenter of the COVID-19 Surge.

Emergency medicine residency program directors (PDs) in areas hit hardest by the initial U.S. COVID-19 pandemic surge faced novel and rapidly evolving organizational, educational, and resident wellness challenges. Despite variations in residency size, hospital setting, and patient population, PDs from eight residencies in "the epicenter" found uniformity in many of the lessons learned. Here we present those lessons and suggestions for high-yield preparation for running a residency during a surge. Of particular importance were frequent, transparent communication and stepwise staffing plans. Illness of residents and other staff occurred early and were substantially reduced as personal protective equipment protocols tightened. Wellness was compromised by anxiety and illness, with varying timelines. New, rich educational opportunities emerged. All programs declared ACGME pandemic status but remained able to maintain some educational offerings. Planning ahead for future surges can significantly reduce the real-time burden for residency leadership, which is particularly important as clinical demands on leadership may also increase with a surge.