scholarly journals LO79: Climbing the learning curve teaching the pediatric emergency physician how to interpret point-of-care ultrasound images

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S35
Author(s):  
C. Kwan ◽  
K. Weerdenburg ◽  
M. Pecarcic ◽  
M. Pusic ◽  
M. Tessaro ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Performance Metrics ◽  
Point Of Care ◽  
Image Interpretation ◽  
Deliberate Practice ◽  
Pediatric Emergency ◽  
Learning Curves ◽  
Point Of Care Ultrasound ◽  
On Line ◽  
On Line Learning

Introduction: Point-of-Care Ultrasound (POCUS) is rapidly being integrated into Pediatric Emergency Medicine (PEM), and image interpretation is an important component of this skill. Currently, PEM physicians often rely on case-by-case exposure and feedback by a POCUS expert physician to learn this skill; however, this may not be efficient, reliable or feasible. Thus, there is a pressing need to develop effective POCUS image interpretation learning and assessment tools. We developed an on-line learning platform that allowed for the deliberate practice of images in four POCUS applications [soft tissue, lung, cardiac and Focused Assessment Sonography for Trauma (FAST)], and determined the quantity of participant skill acquisition by deriving performance metrics and learning curves. Methods: This was a prospective cross-sectional study administered via an on-line learning and measurement platform. Images were acquired from a pediatric emergency department and each POCUS application contained 100 still/video images. Final diagnosis of each image was determined via the consensus of three PEM POCUS experts. PEM fellow and attending study participants were recruited from the USA and Canada and were required to complete the cases of at least one application. We aimed to enroll 200 participants who had to complete a minimum of 100 cases which, based on prior work, would provide sufficient raters for item analyses and comparisons between PEM attendings and fellows. To derive reference standard performance metrics and to validate image interpretations, a unique set of five PEM POCUS experts completed each application. Results: We enrolled 225 PEM physicians, 74 fellows and 151 attendings. For all applications, the Cohens d effect size was large at 0.87, and there was no difference between PEM attendings and fellows with respect to summary performance metrics (accuracy, p= 0.29; sensitivity, p=0.13; specificity, p=0.92). Final accuracy soft tissue, lung, cardiac, and FAST for all participants was 86.4%, 89.6%, 81.6%, 88.0%, respectively, and the corresponding accuracy of PEM POCUS experts for each application was 96.0%, 96.0%, 90.0%, and 93.0%. Learning curves show maximal learning gains (inflection point) up until 65 cases for soft tissue, 70 for FAST, 75 for lung, and 85 for cardiac. Conclusion: Deliberate practice of POCUS image interpretation was effective for ensuring broad domain coverage and predictable skill improvement. Specifically, there was a large learning effect after 100 case interpretations, and 65-85 case interpretations were needed to reach an accuracy threshold of approximately 85%.

scholarly journals LO81: Bridging the GAP: A deliberate practice method for learning Genital Abnormalities in Prepubescent girls

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S35-S36
Author(s):  
K. Boutis ◽  
A. Davis ◽  
M. Pecarcic ◽  
M. Pusic ◽  
M. Shouldice ◽  
...  
Keyword(s):  
Child Abuse ◽  
Sensitivity And Specificity ◽  
Performance Metrics ◽  
Deliberate Practice ◽  
Pediatric Emergency ◽  
Learning Curves ◽  
Future Research ◽  
Physical Examination Skill ◽  
On Line ◽  
On Line Learning

Introduction: Correctly identifying pathology in pre-pubertal females is a high-stakes physical examination skill. Currently, learning this skill relies heavily on case-by-case exposure, which is variable, limited and often results in suboptimal skill. Thus, there is a need to develop and evaluate learning platforms that simulate the presentation and diagnosis of this important clinical task. We developed an on-line learning and assessment platform that allowed the deliberate practice of 158 pre-pubertal female genital image interpretations . We examined the quantity of skill acquisition by deriving performance metrics and learning curves. Methods: This was a prospective cross-sectional study administered via an on-line learning and assessment platform. Colposcopic images were acquired from a child abuse clinic. Two child abuse experts interpreted images to determine case solutions and 40% of cases had medical or traumatic pathology. Further, to validate image interpretations, a unique set of five child abuse and pediatric gynaecology experts reviewed the cases. Study participants were recruited from the USA and Canada and were required to complete all 158 cases. For each image, learners designated cases as normal or abnormal and if abnormal indicated the abnormal area on the image. The primary outcome was the change in accuracy, sensitivity and specificity. Results: We enrolled 107 participants, 26 medical students, 31 pediatric residents, 24 pediatric emergency fellows, and 26 pediatric emergency attendings. For all participants, the change in accuracy was +9.6% for accuracy (<0.001), +1.4% for sensitivity (p=0.6) and +15.7% (p<0.001) for specificity. The final score for accuracy, sensitivity and specificity was 79.5%, 66.1%, and 87.8%, respectively. There was no difference between learner types with respect to summary performance metrics (accuracy, p=0.15; sensitivity, p=0.44; specificity, p=0.54). Learning curves show maximal learning gains (inflection point) up until 100 cases. Conclusion: Deliberate practice of pre-pubertal female image interpretation was effective for ensuring predictable skill improvement for normal cases but was less effective for abnormal cases. Future research could examine how to refine the education tool to better serve diagnostic skill of abnormal cases.

scholarly journals Outcome of Pediatric Emergency Point-of-Care Ultrasound (POCUS) for Management of Skin and Soft Tissue Infection Prior to Ultrasound Program Implementation

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Whitney Phillips, BS ◽  
Benjamin Nti, MD, MSc
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Program Implementation ◽  
Point Of Care ◽  
International Classification Of Diseases ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Department ◽  
Implementation Period ◽  
Classification Of Diseases

Background and Hypothesis: Point-of-care ultrasound (POCUS) is underutilized for evaluation of skin and soft tissue infections (SSTI) in the pediatric emergency department (ED). This study seeks to determine the utilization of POCUS compared to formal radiology ultrasound for SSTI in the pediatric ED prior to an ultrasound program implementation. We hypothesize that POCUS utilization will be low but can lead to a decreased length of stay (LOS) and cost for patients with SSTI.  Experimental Design or Project Methods: This is a retrospective EMR chart review covering pre-implementation (July 2016-June 2017) and post-implementation (July 2018-June 2019) of a POCUS program curriculum. Patients (<18 years old) were included based on screening for diagnoses via the international classification of diseases 9th and 10th revision codes for abscesses and cellulitis. We excluded patients who required admission and subspecialty consult or had other non-SSTI evaluation.   Results: Pre-Implementation period included 160 patients who met inclusion and exclusion criteria. Of these, 16 (10%) received POCUS evaluation and 8 (5%) received a radiology image evaluation. The majority of patients had cellulitis (80%) when compared to abscess (20%). The average LOS for POCUS ultrasound was 173 minutes compared to 304 minutes for radiology evaluation. The total cost for visit was $3,503 for patients evaluated by POCUS compared to $8,875.56 for patients who received radiology imaging.  Conclusion and Potential Impact: Taken together, the pre-implementation assessment of POCUS utilization in the pediatric emergency department was low but associated with decreased LOS and lower total ED cost when applied to SSTI management.

Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 13-14
Author(s):  
Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽  
Maryam Al Ali, MBBS
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Critical Care Unit ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

Telemedicine-guided point-of-care ultrasound can be feasible and effective in a life-threatening situation: The case of a field hospital during the COVID-19 pandemic (Preprint)

2020 ◽  
Author(s):  
Tarso Accorsi ◽  
Karine De Amicis Lima ◽  
Alexandra Brigido ◽  
Deborah Belfort ◽  
Fabio Habrum ◽  
...  
Keyword(s):  
Point Of Care ◽  
Image Interpretation ◽  
Acquisition Time ◽  
Point Of Care Ultrasound ◽  
Field Hospital ◽  
Portable Ultrasound ◽  
Local Staff ◽  
Assessment Protocol ◽  
Life Threatening ◽  
Threatening Situation

BACKGROUND Lightweight portable ultrasound is widely available, especially in inaccessible geographical areas. It demonstrates effectiveness and diagnosis improvement even in field conditions but no precise information about protocols, acquisition time, image interpretation, and the relevance in changing medical conduct exists. The COVID-19 pandemic implied many severe cases and the rapid construction of field hospitals with massive general practitioner (GP) recruitment. OBJECTIVE This prospective and descriptive study aimed to evaluate the feasibility of telemedicine guidance using a standardized multi-organ sonographic assessment protocol in untrained GPs during a COVID-19 emergency in a field hospital. METHODS Eleven COVID-19 in-patients presenting life-threatening complications, attended by local staff who spontaneously requested on-time teleconsultation, were enrolled. All untrained doctors successfully positioned the transducer and obtained key images guided by a remote doctor via telemedicine, with remote interpretation of the findings. RESULTS Only four (36%) general practitioners obtained the appropriate key heart image on the left parasternal long axis window, and three (27%) had an image interpreted remotely on-time. The evaluation time ranged from seven to 42 minutes, with a mean of 22.7 + 12. CONCLUSIONS Telemedicine is effective in guiding GPs to perform portable ultrasound in life-threatening situations, showing effectiveness in conducting decisions.

Accuracy of point-of-care ultrasound by pediatric emergency physicians for testicular torsion

2019 ◽  
Vol 15 (6) ◽  
pp. 608.e1-608.e6 ◽  
Author(s):  
N. Friedman ◽  
Z. Pancer ◽  
R. Savic ◽  
F. Tseng ◽  
M.S. Lee ◽  
...  
Keyword(s):  
Testicular Torsion ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians

Reliability of Neck Mass Point‐of‐Care Ultrasound by Pediatric Emergency Physicians

2019 ◽  
Vol 38 (11) ◽  
pp. 2893-2900 ◽  
Author(s):  
Nir Friedman ◽  
Felicia Tseng ◽  
Ranko Savic ◽  
Mamadou Diallo ◽  
Kate Fathi ◽  
...  
Keyword(s):  
Point Of Care ◽  
Pediatric Emergency ◽  
Neck Mass ◽  
Mass Point ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians
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