Adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 Guidelines in Acute Point-of-Care Ultrasound Research.

Abstract

IMPORTANCE Incomplete reporting of diagnostic accuracy research impairs assessment of risk of bias and limits generalizability. Point-of-care ultrasound has become an important diagnostic tool for acute care physicians, but studies assessing its use are of varying methodological quality.

OBJECTIVE To assess adherence to the Standards for Reporting of Diagnostic Accuracy (STARD) 2015 guidelines in the literature on acute care point-of-care ultrasound.

EVIDENCE REVIEW MEDLINE was searched to identify diagnostic accuracy studies assessing point-of-care ultrasound published in critical care, emergency medicine, or anesthesia journals from 2016 to 2019. Studies were evaluated for adherence to the STARD 2015 guidelines, with the following variables analyzed: journal, country, STARD citation, STARD-adopting journal, impact factor, patient population, use of supplemental material, and body region. Data analysis was performed in November 2019.

SIÊU ÂM CƠ VÂN LY GIẢI [DO CHẤN THƯƠNG]

Sonographic appearance of rhabdomyolysis – a systematic review of the literature 

Łukasz Sein Anand, Wojciech Kosiak

Abstract 

Rhabdomyolysis is the process of striated muscle cell lysis, during which proteins and microelements such as myoglobin are released into the bloodstream. It is important to diagnose rhabdomyolysis as soon as possible and start the treatment according to severity, as it is a state that significantly increases the mortality of the patients. The current gold standard of rhabdomyolysis diagnosis is the creatine kinase plasma concentration test, but it can be also diagnosed with imaging techniques, such as ultrasound (US). This review aims to gather previously published information regarding sonographic appearance of rhabdomyolysis. We searched through PubMed and ScienceDirect databases for studies using designed queries. After the selection process we were left with 13 studies containing a description of US appearance of rhabdomyolysis confirmed with a CK plasma level test. Findings described in the majority of the cases were muscle thickening, ground glass opacity, traits of edema and anechoic areas. Other than these, there were several less often reported findings. As a conclusion, rhabdomyolysis seems to have its own US appearance, but for now it cannot be precisely specified and needs further research for clarification.

Keywords: ultrasonography; rhabdomyolysis; point-of-care

Rhabdomyolysis seems to have its own US appearance, mostly in a form of muscle thickening, ground glass opacity, traits of edema, anechoic areas and various less often reported lesions. Due to the small number of published cases the typical aspect of rhabdomyolysis is not clear and needs further research for clarification.

FDA relaxes rules on ultrasound in COVID-19

The FDA carved out a special section of the guidance for ultrasound systems, which have become useful in diagnosing patients with COVID-19. The agency said that because ultrasound scanners do not emit ionizing radiation, the FDA believes users can have "additional flexibility," with modifications allowed under the following circumstances:

• Modifications that would allow an ultrasound scanner to be used outside of the environment for which it is cleared, such as a general practitioner's office or a field hospital
• Changes that would enable the acquisition of images by healthcare practitioners who are not trained in sonography, under appropriate supervision
• The addition of lung scanning clinical applications, as long as labeling is included that is based on established practice guidelines, such as from the American Institute of Ultrasound in Medicine (AIUM)
• The availability of probes and machine settings that are suitable for lung scanning, such as probes at a frequency of 3 MHz and higher, and with linear, curvilinear, and phased-array technologies
• The use of a mechanical index (MI) < 1.4 as an indicator for potential biological effects on tissues containing gas bodies

The agency would frown on ultrasound modifications as follows:

• Changes that would result in an increase of the derated maximum acoustic output parameters
• Modifications that would exceed known safety limits in humans, such as a MI ≥ 1.4 for lung images
• Modifications that would allow lay users to acquire images without guidance of healthcare practitioners.

Abdominal Pain: An Unusual -- But Not Rare -- COVID-19 Presentation

• Whitney J. Palmer

April 20, 2020

Fever. Cough. Shortness of breath. These are what have become known as the classic, tell-tale COVID-19 symptoms. But, there’s a different, less common, one that should alert you to possible infection– abdominal discomfort.

Recent literature has revealed that as many as 20 percent of patients present to the hospital with a digestive symptom, such as diarrhea, vomiting, pain, accompanying their respiratory symptoms. And, roughly 5 percent show up with an abdominal complaint alone.
This is where abdominal radiologists can play an integral role, said industry experts in a recent article published in the American Journal of Roentgenology. A team, led by Abraham Dachman, M.D., professor of radiology and abdominal imaging specialist with UChicago Medicine, shared three cases where patients were referred for abdominal imaging and providers distinguished findings indicative of COVID-19 infection in the lung base.

“It’s important not to be lulled into a false sense of security by a chief complaint of abdominal pain,” Dachman wrote. “The fact that we observed several patients presenting in this way in such a short time period suggests that although abdominal symptoms are an unusual presentation of the infection, they are not rare, and abdominal radiologists must be on the lookout to diagnose COVID-19, even when it is not suspected clinically.”

Because these findings first appeared on abdominal scans, Dachman wrote, it’s important for all radiological sub-specialties to be aware that COVID-19 can produce abdominal complaints.

“Careful evaluation of the lung bases for the typical nodular, peripherally distributed ground-glass opacities may lead to the correct diagnosis before progressive respiratory manifestations,” he wrote. “An early diagnosis is helpful not only in patient care, but also in allowing healthcare workers to be prepared with the appropriate personal protective equipment.”

5 steps to safe scanning with ultrasound during COVID-19

By Theresa Pablos, AuntMinnie staff writer

April 15, 2020 -- Ultrasound experts released guidelines for performing safe scans during the ongoing COVID-19 crisis. The guidelines, which were published on April 4 in Ultrasound in Medicine and Biology, reinforce standard cleaning and disinfection protocols, as well as introduce new measures in light of the pandemic.

The advice comes from an infectious disease expert and ob/gyn doctor on behalf of the World Federation for Ultrasound in Medicine and Biology Safety Committee. While the authors know that not every guideline will apply to all clinicians, they hope the guidance contributes to the safety practitioners and patients.

Some doctors have been using ultrasound systems to perform lung sonography on patients with COVID-19. While ultrasound equipment has multiple benefits, including use at the bedsides of patients, precautions still must be taken to ensure the safety of clinicians, staff, and patients.

The guidelines detail five domains of recommendations for ultrasound safety during the ongoing pandemic.

1. Socially distance patients

Healthcare settings performing ultrasound scans should be mindful of social distancing for patient safety. This includes scheduling appointments at infrequent intervals, spacing seats in waiting rooms at least six feet apart, and being mindful of the time during scheduled visits.

Practitioners also should ideally limit visitors to a maximum of one person, the guidelines noted. However, video visits or phone calls could be a way to virtually bring additional visitors to appointments.

2. Use PPE

Personal protective equipment (PPE) is vital to protect clinicians and staff during the ongoing pandemic.

Clinicians and staff should use a surgical face mask before entering a patient room or care area, the authors noted. In addition, respirator masks, such as N95 masks, should be used for procedures that generate aerosol.

Gloves and associated hand hygiene are also essential for professionals who use ultrasound equipment. Ultrasound staff should perform adequate hand hygiene before and after patient visits, as well as after touching potentially infectious surfaces or removing PPE.

Clinicians who are at increased health risk due to the pandemic should not perform ultrasound procedures, the authors noted.

3. Prepare the room

At the beginning of the day, the ultrasound room should be cleaned by wiping all surfaces and equipment with a low-level disinfectant. The authors also advised removing unnecessary accessories and replacing fabric chairs with ones that can be easily wiped down with disinfectant.

Between patient visits, staff should wipe down the bed or couch. They should also use gloves to fold and dispose of paper covers.

If possible, the authors recommended scanning patients with suspected or confirmed cases of COVID-19 at the end of the day. This allows extra time for vigorous cleaning and disinfection, they noted.

4. Disinfect and clean the equipment

Ultrasound transducers and cables should be cleaned and disinfected between patients.

Transducers used for lung ultrasound scans can be cleaned with a low- to intermediate-level disinfectant, the authors noted. Staff should also wear gloves and perform hand hygiene when cleaning and disinfecting equipment.

The authors recommended dedicating at least one ultrasound machine specifically for patients with suspected or confirmed cases of COVID-19. Further, clinicians should keep the minimum number of transducers needed out and available, while storing the rest behind cabinet doors

5. Use single-use gel packets

Finally, in light of the pandemic, the authors recommended single-use, nonsterile gel packets for external ultrasound examinations on patients with confirmed or suspected cases of COVID-19.

When gel packets are not available, the authors advised clinicians to use gel bottles for external exams only. However, these bottles should not be refilled or heated, they noted.

The authors further recommended that clinicians keep one hand clean for patient interactions while using their other "semi-clean" hand to dispense gel and perform other nonpatient tasks, such as typing.