Try a new search

Format these results:

Searched for:

person:menlos01

Total Results:

3


Emergency physician-performed bedside ultrasound in patients with undifferentiated abdominal pain [Meeting Abstract]

Kurkowski, E; Blackstock, U; Menlove, S; Chandra, A; Vermeulen, M; Carmody, K
Study Objective: Abdominal pain is a common complaint and comprises approximately 25% of all patients who present to the emergency department (ED). More than 25% of patients presenting to the ED with uncomplicated abdominal pain have computed tomography (CT) scans during their visit. The radiology literature has shown that despite the large number of CTs performed on patients in the ED presenting with abdominal pain, less than half (48%) are actually diagnostic. The objective of this study is to determine if performing a bedside screening ultrasound (US) on patients who present to the ED with undifferentiated abdominal pain can result in a reduction in CT scan usage. We hypothesize that performing a bedside US will decrease the use of CT imaging in the ED by 15% in patients with abdominal pain. Methods: This is a preliminary prospective observational study of ED patients at two urban academic medical centers beginning December 2014. Inclusion criteria include all patients between the ages of 18 and 65 who present with abdominal pain and have a CT of the abdomen and pelvis performed. Patients with an extensive abdominal surgical history or those who end up not having a CT are excluded. Emergency physician co-investigators trained in US, blinded to CT results, performed the following studies: a Focused Assessment with Sonography in Trauma (FAST) exam, right upper quadrant US, bilateral renal US, an abdominal aorta US, and a right lower quadrant US. All US results were discussed with the treating physician and any changes in management were documented. Medical records were reviewed for the final results of all CTs. Results: We calculated a sample size of 200 patients in order to reduce CT scan usage from 25% to 10%. Our preliminary data identified 31 eligible patients of which 28 were enrolled in the study. Three patients have been dropped due to the CT being canceled. Twenty-five patients received both the US and CT in the ED and were included in the analysis. Eleven patients (44%) had a normal US and no significant findings on a subsequent CT. Four patients (16%) had a normal US, but a positive CT. Two of these four had mild hydronephrosis on CT that was missed on US and two had more complicated diagnoses of fistulizing Crohn's and diverticulitis. Ten patients (40%) had a positive US, of which eight had the same diagnosis confirmed on CT and two patients (8%) had CT findings that differed from the US: one had acute appendicitis on US, but renal colic on CT and one had a possible SBO on US but a rectus muscle hematoma on CT. Ultrasound could have theoretically reduced CT utilization in 32% of patients. Although three patients were dropped, two of these had the CT scan canceled and a change in management based on US findings. The two diagnoses were appendicitis and cholelithiasis and both had subsequent radiology US confirming the findings. Therefore, our preliminary total theoretical and actual CT usage reduction is 40%. Conclusions: These preliminary findings suggest that ED performed bedside US in patients with uncomplicated abdominal pain may significantly reduce CT utilization. Bedside US will not replace CT in all patients and subsequent imaging may still be required. However, incorporating US into an abdominal pain algorithm may reduce radiation exposure, length of stay and costs associated with unnecessary CT usage in the ED
EMBASE:72032823
ISSN: 0196-0644
CID: 1840812

Inter-rater reliability between expert emergency physician sonographers reviewing deep venous thrombosis ultrasound studies [Meeting Abstract]

Novik, J; Zakharchenko, S; Vermeulen, M; Berkowitz, R; Blackstock, U; Menlove, S
Background: Lower extremity compression ultrasound (US) for deep venous thrombosis (DVT) assessment by emergency physicians varies in technique and accuracy across published reports. This stems from differences in experience and training as well as paucity of data describing the minimal components needed to perform an accurate exam. Furthermore, no data exists describing emergency physician agreement during formal DVT ultrasound reviews. Emergency physician reviewer agreement is critical to developing a universal, standardized, and accurate approach to lower extremity compression US in the emergency department (ED). Study Objectives: This study evaluates agreement between expert sonographer reviewers in each component of the lower extremity compression US performed at our institution. We hypothesized emergency physician expert reviewers will strongly agree on all components of the review process. Methods: This is a prospective, observational study of ED patients at an urban, academic ED. Adult patients receiving an ED lower extremity compression ultrasound for DVT assessment prior to any other imaging study for DVT assessment were eligible. Enrollment was based on a convenience sample. Lower extremity compression US was performed by the treating physician per our departmental standard method: incremental compression and evaluation for complete coaptation of deep veins are performed from the common femoral vein and saphenous vein junction terminating ten centimeters distal over thigh, and again starting at the popliteal vein (PV) and terminating at the PV trifurcation. Data to calculate a Wells DVT score was also collected. ED lower extremity compression US studies were later evaluated by two of three expert ultrasound reviewers using a checklist of predetermined critical components (Table 1). These components were based on a literature review of exam elements thought to be valuable for DVT assessment and are included in our standard review process. Each category was judged as either present or !
EMBASE:71668074
ISSN: 0196-0644
CID: 1362582

Report on the medical student view from ground zero-new york city, 2001 [Letter]

Pancu, Diana; Menlove, Stephen
PMID: 11927468
ISSN: 1069-6563
CID: 26983