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Emergency thoracic ultrasound and clinical risk management

PURPOSE: Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk as...

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Autores principales: Interrigi, Maria Concetta, Trovato, Francesca M, Catalano, Daniela, Trovato, Guglielmo M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308587/
https://www.ncbi.nlm.nih.gov/pubmed/28223817
http://dx.doi.org/10.2147/TCRM.S126770
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author Interrigi, Maria Concetta
Trovato, Francesca M
Catalano, Daniela
Trovato, Guglielmo M
author_facet Interrigi, Maria Concetta
Trovato, Francesca M
Catalano, Daniela
Trovato, Guglielmo M
author_sort Interrigi, Maria Concetta
collection PubMed
description PURPOSE: Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. PATIENTS AND METHODS: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. RESULTS: Three hundred and seventy emergency TUS scans (excluding trauma patients) were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion); in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed tomography (CT). In seven patients, even if chest disease was identified by CXR, such diagnoses were significantly modified by ultrasound, and CT confirmed that TUS was more appropriate. The overall respective individual performances of CXR and TUS for the diagnosis of a pleural–pulmonary disease in emergency are good, with accuracy >95%. CONCLUSION: About 20% of pneumonia cases were detectable only by CXR and 20% only by TUS and not by CXR; ie, about 40% of patients may have been misdiagnosed if, by chance, only one of the two tools had been used. The concurrent use of TUS and CXR increases the overall sensitivity and specificity. The contribution of expert telementoring and final reappraisal is a valuable and sustainable element for emergency physicians’ training and performance, contributing reasonably to mitigation of clinical risks.
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spelling pubmed-53085872017-02-21 Emergency thoracic ultrasound and clinical risk management Interrigi, Maria Concetta Trovato, Francesca M Catalano, Daniela Trovato, Guglielmo M Ther Clin Risk Manag Original Research PURPOSE: Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. PATIENTS AND METHODS: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. RESULTS: Three hundred and seventy emergency TUS scans (excluding trauma patients) were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion); in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed tomography (CT). In seven patients, even if chest disease was identified by CXR, such diagnoses were significantly modified by ultrasound, and CT confirmed that TUS was more appropriate. The overall respective individual performances of CXR and TUS for the diagnosis of a pleural–pulmonary disease in emergency are good, with accuracy >95%. CONCLUSION: About 20% of pneumonia cases were detectable only by CXR and 20% only by TUS and not by CXR; ie, about 40% of patients may have been misdiagnosed if, by chance, only one of the two tools had been used. The concurrent use of TUS and CXR increases the overall sensitivity and specificity. The contribution of expert telementoring and final reappraisal is a valuable and sustainable element for emergency physicians’ training and performance, contributing reasonably to mitigation of clinical risks. Dove Medical Press 2017-02-09 /pmc/articles/PMC5308587/ /pubmed/28223817 http://dx.doi.org/10.2147/TCRM.S126770 Text en © 2017 Interrigi et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Interrigi, Maria Concetta
Trovato, Francesca M
Catalano, Daniela
Trovato, Guglielmo M
Emergency thoracic ultrasound and clinical risk management
title Emergency thoracic ultrasound and clinical risk management
title_full Emergency thoracic ultrasound and clinical risk management
title_fullStr Emergency thoracic ultrasound and clinical risk management
title_full_unstemmed Emergency thoracic ultrasound and clinical risk management
title_short Emergency thoracic ultrasound and clinical risk management
title_sort emergency thoracic ultrasound and clinical risk management
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308587/
https://www.ncbi.nlm.nih.gov/pubmed/28223817
http://dx.doi.org/10.2147/TCRM.S126770
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