Looking for "core" Emergency Ultrasound articles?

I've collected a few top articles for each of the more common Emergency Ultrasound modalities. Each article is linked to the PDF for educational purposes. I welcome feedback regarding the articles I have listed below, as well as recommendations for other important articles to add to the list.
  • Aorta articles

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  • Appy articles

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    • 2000 Chen et al. AJEM. EP-performed RLQ ultrasound in Taiwan ED.
    • 2006 Doria et al. Radiology. Test characteristics of U/S versus CT for the evaluation of appendicitis.
    • 2008 Fox et al. European J of Emerg Med. EP-performed RLQ U/S in a mixed population of adults and pediatric patients (>60% over age 19yo).
    • 2009 Ramarajan et al. AEM. U/S first approach to appy identification. Using pathway, there was an acceptable negative appy rate of 7% and a missed appy rate of 0.5%. If U/S visualized a normal appendix, no CT needed. If U/S + for appy, then OR. If U/S equivocal (non-visualized), clinical decision-making.
    • 2011 Rosen et al. J Am Coll Radiol. ACR Appropriateness Criteria for appendicitis imaging.
    • 2012 Bachur et al. Annals of EM. The sensitivity of ultrasonography for appendicitis improves with a longer duration of abdominal pain, whereas CT demonstrated high sensitivity regardless of pain duration.
    • 2012 Conners and Schroeder. Annals of EM. Editorial to the Bachur et al article above. Authors demonstrate concern for the U/S first approach based on the findings that the sensitivity of U/S in the first 24hrs of abdominal pain is inadequate. Worth a read (though I disagree to some extent).
    • 2013 Quigley et al. Insights Imaging. Great review of U/S for appendicitis, with emphasis on sono findings and technique.
    • 2013 Russell et al. PEC. Great study confirmed that a clinical practice guideline, emphasizing early pediatric surgical consultation and an "ultrasound-first" approach. Markedly lower CT rates with no incremental increase in missed appy or negative appy rate.
  • Biliary articles

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    • 1999 Blaivas et al. AEM. Decreased ED LOS for patients undergoing EM-performed bedside ultrasound of the gallbladder (and in a teaching hospital to boot!).
    • 2001 Durston et al. AJEM. Compared to formal biliary study, EP-performed exam had comparable accuracy but higher indeterminate rates. Formal radiology studies may have marginal improved quality, but also had higher costs.
    • 2001 Kendall et al. JEM. Compared to formal biliary study, EP-performed exam had comparable accuracy for detecting stones and higher sensitivity in detecting a sono-Murphy sign. Almost all studies completed in less than 10 minutes.
    • 2001 Rosen et al. AJEM. EP-performed biliary exam compared to formal U/S, with regard to cholelithiasis (92% sensitivity, 78% specificity, 86% PPV, 88% NPV) and cholecystitis (91% sensitivity, 66% specificity, 70% PPV, 90% NPV). Test characteristics improved with more experience.
    • 2009 Gaspari et al. JEM. Accurate biliary ultrasound performance/interpretation by EM attendings/residents after 25+ studies.
  • Cardiac articles

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    • 2001 Blaivas et al. AEM. Patients presenting with cardiac standstill on bedside echo do not survive to leave the ED, regardless of their electrical rhythm. N=136 with cardiac standstill, of which 71 had an identifiable rhythm.
    • 2002 Moore et al. AEM. Great correlation between EF estimation by EP's compared to cardiologists (same as cardiologists' interobserver variation).
    • 2003 Randazzo et al. AEM. High levels of agreement between EP sonographers' assessment of LVEF and IVC/CVP and a formal echo.
    • 2004 Alexander et al. Am Heart J. Medical house staff with limited echo training can assess LVEF and pericardial effusion with moderate accuracy.
    • 2005 Kobal et al. Am J Cardiol. The diagnostic accuracy of medical students using hand-carried U/S after brief echo training was superior to that of experienced cardiologists performing cardiac physical examinations.
    • 2012 Blyth et al. AEM. Patients VERY RARELY experience ROSC when an echo performed during cardiac arrest demonstrates an absence of cardiac activity. Though there's still a chance, at least per this systematic review.
    • 2012 Cureton et al. J Trauma. The absence of cardiac motion (especially the absence of both cardiac motion and electrical activity) is highly predictive of death. Cardiac ultrasound had an NPV approaching 100% for survival to hospital admission.
    • 2012 Haydar et al. Annals of EM. Bedside echo of septic patients helpful. Increased diagnostic/management certainty with U/S data on contractility, IVC diameter, and IVC collapsibility.
  • CODE articles

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    • 2001 Rose et al. AJEM. Sonographic protocol for the evaluation of the undifferentiated hypotensive patient (UHP). Looks for free fluid, cardiac function, and abdominal aorta pathology.
    • 2004 Jones et al. Critical Care Med. Goal-directed U/S protocol for undifferentiated hypotension. LV function, RV size, effusion/tamponade, AAA, free fluid, IVC collapsibility. Protocol resulted in fewer viable diagnostic etiologies and a more accurate physician impression of final diagnosis.
    • 2007 Breitkreutz et al. Critical Care Med. Developed a focused echo evaluation in resuscitation management (FEER), to occur in the brief pauses during CPR.
    • 2008 Hernandez et al. Resuscitation. Nice review of the literature involving ultrasound and resuscitative conditions. Also introduces a proposed protocol: C.A.U.S.E. or Cardiac arrest ultrasound exam.
    • 2010 Perera et al. Emerg Med Clinics of NA. Introduces the RUSH exam (Rapid Ultrasound in SHock), a 3-part bedside physiologic assessment simplified as: The pump, the tank, and the pipes. Great review of the evaluation of critically ill patients using U/S.
  • DVT articles

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    • 1998 Cogo et al. BMJ. In patients with a normal 2-point compression ultrasound, anticoagulation may be withheld. A normal repeat ultrasound in 1 week effectively rules out DVT.
    • 2000 Blaivas et al. AEM. EP's can perform duplex ultrasound examinations accurately (98% agreement with formal studies) and quickly (3min 28sec). Study physicians recorded vein compressibility, presence of blood flow on color Doppler, and augmentation in both the femoral and popliteal veins.
    • 2001 Frazee et al. JEM. Compared to formal duplex U/S, ED compression U/S using 2-point compression had an 89% sensitivity, 76% specificity, and 96% negative predictive value. In the 2 false-negatives, compression was normal for both, but the duplex scan showed "other" signs of DVT; neither patient was treated for DVT (??).
    • 2004 Theodoro et al. AJEM. While maintaining high levels of agreement with formal duplex studies, EP-performed compression U/S (CFV up to 2cm distal to bifurcation, PV to trifurcation) produced a time saving of 125 minutes (triage to EP disposition).
    • 2007 Blaivas. Critical Care Med. Great review of bedside ultrasound in the detection of venous thromboembolism.
    • 2007 Magazzini et al. AEM. ED U/S examination yielded a high negative predictive value (100%) and good positive predictive value (95%). Essentially a full-leg evaluation, also did color imaging of the flow and with a Doppler analysis of venous flow at both proximal and distal levels.
    • 2008 Bernardi et al. JAMA. Equivalency noted between formal duplex and the combined strategy of 2-point compression and D-dimer. If both 2-point and D-dimer negative, work-up ended. If 2-point negative and D-dimer positive, then repeat U/S at 1 week.
    • 2008 Burnside et al. AEM. Systematic review of six studies suggesting that EP-performed compression U/S may be accurate for the diagnosis of DVT compared with radiology-performed ultrasound.
    • 2008 Fields and Goyal. EM Clinics of NA. Great review on thromboembolism.
    • 2008 Kline et al. Annals of EM. Study authors' conclusion: The overall diagnostic accuracy of EP–performed ultrasonography is intermediate but may be improved by pretest probability assessment. Take away: this was a heterogeneous group of sonographers (attending physicians, fellows and supervised residents, and midlevel ED providers). Accuracy improved with more patients enrolled (experience counts). 2 residents, who rated the exam as very difficult, accounted for 5 of the 8 false negatives (again, experience counts). Used a 3-point compression protocol.
    • 2010 Crisp et al. Annals of EM. ED-performed 2-point compression U/S had a high sensitivity (100%) and specificity (99%). Again, a heterogeneous group of sonographers (both EM and IM and family med). Results provide a contrast to Kline's study.
    • 2010 Shiver et al. AJEM. Sensitivity and specificity of EP-performed U/S when compared to CT-venogram in the diagnosis of DVT was 86% and 100%, respectively. Small sample size, wide confidence intervals, missed an iliac clot (to be expected), 3-point compression protocol.
  • FAST articles

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    • 1995 Lichtenstein and Menu. Chest. Pnuemothorax study by the father of thoracic U/S. Blinded investigator demonstrated that U/S is a great test for PTX; sensitivity was 95.3%, specificity 91.1%, and negative predictive value 100%.
    • 1997 Branney et al. Journal of Trauma. An ultrasound based pathway resulted in significant reductions in the use of invasive DPL and costly CT scanning in the evaluation of blunt abdominal trauma (without risk to the patient).
    • 1998 Sisley et al. Journal of Trauma. Surgeons can accurately detect traumatic effusion. Surgeon-performed thoracic ultrasonography is as accurate but is significantly faster than supine portable chest radiography for the detection of traumatic effusion.
    • 1999 Scalea et al. Journal of Trauma. International consensus conference on the FAST exam. Interesting reading.
    • 2001 Dulchavsky et al. Journal of Trauma. Thoracic ultrasound reliably diagnoses pneumothorax. Used a 4 MHz probe.
    • 2001 McKenney et al. Journal of Trauma. Study introducing a hemoperitoneum score for free fluid accumulation (in five peritoneal regions). The majority of patients with a score > 3 will need surgery. The U/S hemoperitoneum scoring system was a better predictor of a therapeutic laparotomy than initial blood pressure and/or base deficit.
    • 2004 Kirkpatrick et al. Journal of Trauma. Thoracic U/S (EFAST) has comparable specificity to CXR but is more sensitive for the detection of occult PTX after trauma. U/S sensitivity still low (59%) though probably not clinically significant PTX.
    • 2005 Blaivas et al. AEM. With CT as the criterion standard, U/S is more sensitive than flat AP chest radiography in the diagnosis of traumatic PTX. High U/S sensitivity (98%) compared to the Kirkpatrick trial, despite using a micro-convex transducer.
    • 2005 Stengel et al. Cochrane Review. Cochrane review of the FAST exam for blunt abdominal trauma. Authors conclude that there is insufficient evidence to support FAST algorithms for blunt abdominal trauma. Low sensitivity and accuracy, though CT scan usage went down. Pretty disheartening. FAST should not be a stand-alone screening tool based on this analysis. (See Melniker's rebuttal below.)
    • 2006 Melniker et al. Annals of EM. Decreased time to operative care in torso trauma, fewer CT scans, and lower overall hospital charges when using a point-of-care, limited ultrasound (PLUS) protocol.
    • 2007 Moylan et al. JEM. Among normotensive blunt trauma patients, there was a strong association between a positive FAST and the need for therapeutic laparotomy. Unadjusted odds ratio (116) and adjusted odds ratio (44.6) supported this finding.
    • 2008 Bahner et al. Journal of US in Med. Presents the AIUM practice guideline for the performance of the FAST exam. Pretty big deal for ED U/S.
    • 2008 Ma et al. Emerg Med Aus. Article detailing skill acquisition for the FAST exam. More time/studies, more accurate scans.
    • 2009 Melniker LA. Crit US Journal. Rebuttal to the Cochrane review above. Melniker found that an adequately performed FAST exam was highly predictive of "Need for OR" in patients with blunt torso trauma. High sensitivity (98.9%) and specificity (98.1%).
    • 2012 Laselle et al. Annals of EM. False-negative FAST results (severe head injuries and minor abdominal injuries) are associated with certain injury patterns but are not associated with adverse outcomes.
    • 2012 Rowan et al. Radiology. U/S (performed by a staff radiologist or radiology resident) was more sensitive than supine chest radiography and as sensitive as CT in the detection of traumatic pneumothoraces (Canadian study).
  • GI articles

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    • 1999 Suri et al. Acta Radiologica. Compared to CT for the identification of intestinal obstruction, U/S has a sensitivity of 83%, specificity of 100%, and accuracy of 84%. Very low efficacy in determining an etiology for obstruction.
    • 2001 Rettenbacher et al. AJR. U/S for incarcerated hernia (abdominal wall) identification. Sonographic signs: 1) Free fluid in the hernia sac (91% of the incarcerated hernias, 3% of the nonincarcerated hernias) 2) bowel wall thickening in the hernia (88% of the incarcerated hernias, 0% of the nonincarcerated hernias) 3) fluid in the herniated bowel loop (82% of the incarcerated hernias, 3% of the nonincarcerated hernias) and 4) dilated bowel loops in the abdomen (65% of the incarcerated hernias, 0% of the non- incarcerated hernias).
    • 2009 Ramarajan et al. AEM. U/S first approach to appy identification. Using pathway, there was an acceptable negative appy rate of 7% and a missed appy rate of 0.5%. If U/S visualized a normal appendix, no CT needed. If U/S + for appy, then OR. If U/S equivocal (non-visualized), clinical decision-making.
    • 2012 Bachur et al. Annals of EM. The sensitivity of ultrasonography for appendicitis improves with a longer duration of abdominal pain, whereas CT demonstrated high sensitivity regardless of pain duration.
    • 2012 Conners and Schroeder. Annals of EM. Editorial to the Bachur et al article above. Authors demonstrate concern for the U/S first approach based on the findings that the sensitivity of U/S in the first 24hrs of abdominal pain is inadequate. Worth a read (though I disagree to some extent).
    • 2012 Riera et al. Annals of EM. With limited and focused training, pediatric emergency physicians can accurately diagnose ileocolic intussusception in children by using U/S. Sensitivity 85%, specificity 97%, PPV 85%, and NPV 97%.
  • IVC articles

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    • 2005 Lyon et al. AJEM. Nice study of blood donors, looking at IVC diameter changes after donation. Notable decrease in IVC diameter both with expiration and with inspiration.
    • 2006 Brennan et al. Clin J Am Soc Nephrol. Feasibility study in a dialysis center. Checked IVC diameter and collapsibility index. Weight-based volume status noted to be quite different from IVC parameters on U/S. Conclusion that U/S is helpful in predicting euvolemia and potentially avoiding intradialytic adverse events.
    • 2009 Blehar et al. AJEM. Study showing IVC evaluation is good for CHF patients. Respiratory variation of IVC was smaller in patients with CHF (9.6%) than without CHF (46%) and showed good diagnostic accuracy.
    • 2009 Stawicki et al. J Am Coll of Surg. Study looking at correlations between IVC collapsibility and CVP. Intensivist-performed (including EM docs) U/S on a difficult patient population. Take away was that the correlations were best at the extremes (IVC collapsibility of <0.20 and >0.60).
    • 2010 Nagdev et al. Annals of EM. Bedside ultrasonographic measurement of IVC collapsibility > 50% is strongly associated with a low CVP. My take-away is that, once again, the extremes (high or low collapsibility) are more valuable and more reliable.
    • 2010 Wallace et al. AEM. Study showing that IVC measurement location matters. Good: 2cm distal to the hepatic vein inlet (best place) and at the level of the left renal vein. Bad: Junction of the RA/IVC.
  • MSK articles

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    • 1999 Griffith et al. AJR. U/S more sensitive for rib fractures than plain x-rays.
    • 2002 Chern et al. J of Bone and Joint Surg. Prospective review of 27 consecutive wrists with distal radius fractures. U/S as accurate as plain X-rays.
    • 2002 Dulchavsky et al. J Trauma. Extremity U/S is quick and accurate (94%) in identifying fractures. Better for midshaft fractures of the radius/ulna, humerus, femur, or tibia/fibula. Worse for hand/foot, tendon, and femur.
    • 2004 Marshburn et al. J Trauma. MDs with minimal U/S experience evaluated upper arm or leg injuries. 92.9% sensitivity, 83.3% specificity.
    • 2009 Patel et al. PEC. U/S comparable to radiography in fracture identification in kids. Also helpful regarding need for reduction and adequacy of reduction. Agreement between plain film and U/S was around 95%.
    • 2010 Ang et al. AJEM. U/S guidance of distal radius fracture reduction was shown to be effective, equivalent to X-ray.
    • 2011 Chinnock et al. JEM. Prospective study of U/S-guided distal radius fracture reduction, compared to historical control. Sensitivity 94%, specificity 56% for identifying a successful reduction. Overall success rates equivalent between U/S and historical control.
  • Nerve block articles

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    • 2006 Liebmann et al. Annals of EM. Attendings/fellows/residents can all perform U/S-guided nerve blocks of the radial, ulnar, and median nerves quickly and successfully. Prospective study of 11 patients, all of whom had successful blocks for procedures.
    • 2008 Stone et al. AJEM. U/S-guided brachial plexus nerve blocks resulted in shorter ED LOS compared to procedural sedation for patients with upper extremity fractures, dislocations, or abscesses. (Average LOS 106min for blocks, 285min for sedation.)
    • 2012 Haines et al. JEM. 20 patients with isolated hip fractures underwent U/S-guided fascia iliac compartment block by ED physicians. All patients reported decreased pain after then nerve block, with a 76% reduction in mean pain score at 120min.
  • OB/GYN articles

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    • 1998 Burgher et al. AEM. ED stay decreased by TVUS performed at the bedside by ED physicians (165min for ED scans vs 235min for formal scans). Also, fewer calls to consultants.
    • 2000 Blaivas et al. AEM. ED U/S significantly decreased patients’ LOS in the ED (59min less). The decrease in LOS was most apparent for patients presenting during evening and nighttime hours (77min less).
    • 2000 Durston et al. AJEM. 6yr study looking at various measures related to the introduction of ED U/S for 1st trimester cramping and bleeding. Take home from this was that the best strategy would be to perform ED U/S on all of these patients, but to get formal scans when the ED U/S is indeterminate or shows no IUP.
    • 2004 Condous et al. Ultrasound Obstet Gynecol. Examining the ovaries in the 1st trimester is of limited value. 3,000 women evaluated before 14 weeks, any large simple cysts or ALL complex cysts followed up. 166 cysts in study, 3% underwent torsion, no malignancy.
    • 2007 Moore et al. AEM. With regard to ectopics, RUQ free fluid predicts the need for operative intervention.
  • Ocular articles

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    • 2002 Blaivas et al. AEM. EP-performed ocular U/S is highly accurate for ruling out and diagnosing ocular pathology. 61 patient study (including penetrating globe injuries, retinal detachments, CRAO, lens dislocations, vitreous hemorrhage/detachment, etc.), with sinologists in agreement with standard (CT or ophthalmology exam) in 60/61.
    • 2002 Newman et al. Br J Ophth. Described optic nerve sheath diameter (ONSD) measurements for assessing ICP. Measured transversely, 3mm behind the globe. Used control data of > 4.5mm being consistent with increased ICP (or > 4mm in kids <1yo).
    • 2003 Blaivas et al. AEM. One of the original ED studies demonstrating utility of ocular U/S (ONSD) to diagnose elevated ICP. Compared to CT, 100% sensitivity and 95% specificity. Small sample size.
    • 2005 Tsung et al. PEC. Ocular U/S for ICP in children. Establishes upper limit of normal ONSD of 5.0 mm in adults, 4.5 mm in children aged 1-15, and 4.0 mm in infants up to 1 year of age.
    • 2007 Geeraerts et al. Ocular U/S for ICP after TBI is useful and accurate.
    • 2007 Tayal et al. Annals of EM. U/S 100% sensitive and 63% specific for detecting elevated ICP. Used 5mm cutoff, n=59.
    • 2008 Geeraerts et al. Critical Care. Nice review on using ocular U/S for detecting ICP.
    • 2008 Kimberly et al. AEM. Study of 15 patients (38 ocular U/S exams) confirming the threshold of ONSD > 5 mm to detect ICP > 20 cm H2O. 88% sensitivity and 93% specificity.
    • 2009 Le et al. Annals of EM. Negative study for ICP detection in children. 83% sensitivity and 38% specificity. n=64, used 4.5 and 4.0 cutoffs. A few limitations but the study is generally as good as the others. A little disappointing.
    • 2010 Yoonessi et al. AEM. Ocular U/S great for detecting retinal detachment. 48 ED patient with acute visual changes. 100% sensitivity and 83% specificity for retinal detachment identification. False positives were vitreous hemorrhages.
    • 2011 Dubourg et al. ICM. Systematic review of 6 studies including 231 patients. Ocular U/S and ONSD with good level of diagnostic accuracy for detecting increased ICP.
    • 2011 Shinar et al. JEM. Prospective observational study of ocular U/S to detect retinal detachment. Minimal training, study included residents, attending, and PAs. EPs achieved a 97% sensitivity and 92% specificity on 92 examinations (29 retinal detachments).
  • Pediatric articles

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  • Policy articles

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  • Procedural ultrasound articles

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    • 2007 Nomura et al. J US Med. Study demonstrating the use of ultrasound for LP; noted to significantly reduce the number of failures in all patients and improve the ease of the procedure in obese patients. n=46.
  • Renal articles

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    • 1993 Chan. J Nero Nurs. U/S for bladder volume measurements. 90 exams, high correlation with actual catheterized volume.
    • 1998 Rosen et al. JEM. Study of U/S identification of hydronephrosis and prediction of ureterolithiasis. Compared to CT, sensitivity 72%, specificity 73%, PPV 85%, NPV 54%, accuracy 72% (with regard to hydro). Ureteral stone prediction after U/S: 86% PPV, 75% NPV.
    • 2000 Sheafor et al. Radiology. Radiologist study of U/S for hydro and ureteral stone identification. 61% sensitivity for ureteral stone. 92% sensitivity for ANY clinically relevant abnormality (hydro and/or urolithiasis). Nonenhanced CT was better.
    • 2002 Fowler et al. Radiology. Another radiologist study of U/S identification of renal calculi. U/S had a 24% sensitivity compared to CT. Mean size of calc identified was 7mm. 73% of calc not visualized were less than 3mm.
    • 2004 Noble and Brown. EM Clinics of NA. Great review article on renal ultrasonography.
    • 2005 Gaspari and Horst. AEM. EP-performed U/S of the kidneys shows very good sensitivity and specificity for diagnosing renal colic in patients with flank pain and hematuria. 83% sensitivity and 92% specificity.
    • 2010 Edmonds et al. CJEM. Normal renal U/S predicts very low likelihood (<1%) for urologic intervention within 90 days for adult ED patients with suspected urolithiasis.
    • 2012 Dalziel and Noble. EMJ. Another great review article on U/S for renal colic, including imaging algorithm based on identification of hydronephrosis.
  • Soft tissue articles

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    • 2005 Lyon et al. AEM. U/S for suspected peri-tonsillar abscess is safe and accurate. n=43, 35 patients with abscess on U/S, only one false positive (no pus).
    • 2005 Squire et al. AEM. Great study proving that bedside U/S of soft tissue cellulitis versus abscess. Shown to improve accuracy in detection of abscesses.
    • 2006 Tayal et al. AEM. Another great study looking at changes in management based on soft tissue ultrasound. n=126, U/S changed management in 56% of cases.
    • 2010 Adhikari and Blaivas. J US Med. Study looking at U/S differentiation of soft tissue abnormalities versus joint effusion. For 54 patients, planned joint aspiration went from 72% before U/S to 37% after U/S.
    • 2011 Gaspari et al. Annals of EM. Study proving that U/S guided needle aspiration is insufficient therapy for skin abscesses. Of note, CA-MRSA makes aspiration as well as traditional I&D less successful (i.e. expect treatment failures even when you do everything right).
    • 2012 Iverson et al. AJEM. Similar to Tayal's study above, in the Peds ED U/S also led to management changes in the evaluation of soft tissue infections. Smaller effect, though, with 14% management changes.
  • Thoracic articles

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    • 2006 Weaver et al. AEM. In this cadaver study, the presence of lung sliding was shown to be an accurate method for confirmation of ETT placement.
    • 2007 Frassi et al. J Card Failure. Formal echo study looking at "ultrasound lung comets" (comet tails) in 290 consecutive patients with dyspnea and/or CP admitted to the Cardio-Pulmonary service (Italy). The presence of tons of comet tails portended a poor prognosis (useful prognostic stratification). Univariate and multivariate analyses.
    • 2008 Lichtenstein and Meziere. CCM. Study of a variety of lung U/S profiles that led to correct diagnoses in 90.5% of cases. Included PE, PTX, pulmonary edema, and pneumonia.
    • 2008 Volpicelli et al. AJEM. Lung U/S B line pattern mostly clears after adequate medical treatment of acute CHF.
    • 2009 Brook et al. J US Med. Study of radiology residents performing an extended FAST (eFAST). Comparison of CT chest (criterion standard), CXR, and U/S. CXR identified 16%, U/S identified 53%. Compared to CT, eFAST: 47% sensitive, 99% specific, 87% PPV, 93% NPV. ALL moderate PTX identified by eFAST. The PTX missed were not clinically significant.
    • 2009 Liteplo et al. AEM. U/S for B lines is useful in diagnosing CHF. Better likelihood ratios than for pro-BNP. 2-zone and 8-zone scans performed similarly.
    • 2009 Noble et al. Chest. Study of dialysis patients, checked for B lines pre- and post-dialysis. Significant reductions after dialysis; evidence of real-time B line resolution with fluid removal.
    • 2009 Parlamento et al. AJEM. U/S can reliably detect pneumonia. Convenience sample of patients with clinically suspected pneumonia, n=49. Of the 32 confirmed cases of pneumonia, U/S picked up 31 (96.9%) and CXR 24 (75%). Any U/S+ but CXR- case had a CT performed, confirming the U/S finding.
    • 2010 Wilkerson and Stone. AEM. U/S is more sensitive for PTX than a supine CXR. Meta-analysis of 4 prospective observational studies, n=606. For detection of PTX, U/S has an 86-98% sensitivity and 97-100% specificity. In contrast, supine CXR has a sensitivity of 28-75%.
    • 2011 Ding et al. Chest. Bigger meta-analysis of 20 studies, again showing that U/S is superior to chest radiography. For non-radiologists, U/S had a pooled sensitivity of 89% and specificity of 99%. In comparison, CXR was 52% and 100%, respectively.
    • 2011 Zanobetti et al. Chest. When performed by highly trained physicians, U/S and radiography had high concordance in most pulmonary diseases (Kappa = 95%). U/S was more accurate in distinguishing free pleural effusion.
    • 2012 Volpicelli et al. AJEM. Lung U/S was able to identify pulmonary pathologies in the setting of negative CXR. Other tests , such as a D-dimer and WBC count did not predict the final diagnosis.
  • Vascular access articles

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    • 1996 Randolph et al. CCM. Meta-analysis of 8 (out of 208) randomized controlled trials of venous and arterial catheter management. U/S guidance significantly decreases IJ and SC catheter placement failure, decreases complications, and decreases the need for multiple attempts when compared to the landmark technique.
    • 1997 Hilty et al. Annals of EM. Real-time U/S-guided femoral vein catheterization required fewer needle passes (2.3 vs 5), produced a lower rate of inadvertent arterial catheterization (0% vs 20%), and had a higher rate of success (90% vs 65%) during CPR than the standard landmark-oriented approach. Interesting finding: U/S demonstrated that palpable femoral pulsation during CPR is venous rather than arterial.
    • 1999 Keyes et al. Annals of EM. ED-based study demonstrating that U/S-guided brachial and basilic vein cannulation is safe, rapid, and has a high success rate in ED patients with difficult peripheral intravenous access. Infiltration noted in 8% of patients. First attempt success in 73%.
    • 2003 Hind et al. BMJ. Meta-analysis of RCTs regarding U/S guided cannulation. Compared with the landmark method, real time U/S guidance for cannulating the internal jugular vein in adults was associated with a significantly lower failure rate both overall and on the first attempt. Limited evidence favored U/S guidance for subclavian vein and femoral vein.
    • 2003 McGee and Gould. NEJM. Great review of central venous catheterization and complications. Discussion of U/S guidance.
    • 2004 Sandhu and Sidhu. Br J Anaesth. Basilic and cephalic vein cannulation techniques described.
    • 2005 Costantino et al. Annals of EM. U/S-guided peripheral intravenous access is more successful than traditional ‘‘blind’’ techniques (97% vs 33%), requires less time (13min vs 30min), decreases the number of percutaneous punctures (1.7 vs 3.7), and improves patient satisfaction in the subgroup of patients who have difficult intravenous access.
    • 2005 Milling et al. CCM. Study of IJ placement. U/S-guided approach was superior to the landmark approach, dynamic U/S better than static U/S.
    • 2007 Mills et al. Annals of EM. Prospective cohort study of 25 subjects with difficult peripheral IV access. Described approach to placing a 15-cm catheter into the deep brachial or basilic vein. 23 catheters successfully placed. Only 4% complication rate, but wide confidence intervals.
    • 2009 Panebianco et al. AEM. U/S-guided peripheral IV placement success not related to patient characteristics or probe orientation. Success associated with a bigger vessel and a shallow depth. Depth > 1.6cm associated with markedly lower success rates, as with vessel diameters < 3mm.
    • 2009 Stein et al. Annals of EM. Negative study with regard to U/S-guided peripheral IV. Small study, 59 patients with 2 failed IV attempts were randomized to U/S or non-U/S. No difference in the number of attempts or time to successful cannulation or patient satisfaction. Runs contrary to previous studies. A fair number of the sonographers were less experienced and may have skewed results.
    • 2011 Shiloh et al. Chest. Meta-analysis of 4 trials, demonstrating that use of U/S-guidance for radial artery catheterization improved first-pass success rate (71% improvement compared to the palpation method).
    • 2012 Elia et al. AJEM. Longer IV catheters (12cm) have lower failure rates than short IV catheters (5cm) for deep vein cannulation. Same success rates, but less failure in the long catheters (14%) compared to the short catheters (45%). Cannulation for both involved Seldinger technique. Sterile technique (including sterile gloves) used in the long catheter cannulation.
    • 2012 Rickard et al. Lancet. Big trial looking at peripheral IV catheters and scheduled replacement at 72-96 hours. Importantly, there was no increased risk of phlebitis or other serious adverse events in the group with an IV catheter longer than 4 days. Take home point: PIV catheters can be removed as clinically indicated.
    • 2012 Shokoohi et al. Annals of EM. U/S-guided peripheral IV placement leads to fewer central lines. The decrease was particularly notable among non critically ill patients (4-5% fewer/month) and discharged patients (7.6% fewer/month). The central venous catheter rate decreased by 80% between 2006 and 2011, the time period in which EM residents and ED techs were trained in U/S-guided PIV placement.
    • 2012 Teismann et al. JEM. Case series of 9 patients undergoing an U/S-guided placement of a standard catheter-over-needle device into the IJ vein. They used sterile technique (minus the full-body draping, sterile gown, and surgical mask). Trendelenburg positioning, and 2.5 inch IV catheters. Time of procedure was 2.5-7min. No complications.