This website is intended for healthcare professionals only.
Take a look at a selection of our recent media coverage:
24th May 2022
Point-of-care ultrasound (POC ultrasound) has a high sensitivity and specificity for the identification of testicular torsion in paediatric patients within an emergency care setting. This was the conclusion of a systematic review and meta-analysis of studies by Japanese researchers from Tokyo, Japan.
Testicular torsion is defined as the rotation of the longitudinal axis of the spermatic cord, resulting in the absence of testicular blood flow. The estimated annual incidence of the condition among those younger than 18 years is 3.8 per 100,000 with a mean age of 10.6 years at presentation. Common symptoms include acute scrotum pain, erythema and scrotal swelling. It has been suggested that a scoring system based on testicular swelling, a hard testicle, an absent cremasteric reflex, nausea/vomiting and high riding testis, can potentially diagnose or rule out testicular torsion in 80% of cases.
POC ultrasound use within an emergency department in children with suspected acute appendicitis has been shown to be diagnostic. Moreover, although ultrasound has been found to be an effective imaging modality for diagnosing testicular torsion in adult patients with acute scrotal pain, the diagnostic accuracy of POC ultrasound for testicular torsion in children has not been fully assessed.
In the current study, the Japanese team undertook a meta-analysis of studies in children (under 19 years of age) who presented at an emergency department with symptoms suggestive of an acute scrotum. The researchers included any studies which used POC ultrasound but excluded both case studies and case series with less than 10 patients. The primary outcome was an assessment of the diagnostic accuracy of POC ultrasound for paediatric testicular torsion based on sensitivity and specificity.
POC ultrasound and testicular torsion
A total of four studies including 784 patients were included in the analysis. The median age of children in the four studies ranged from 10 to 13 (although it was not reported in one study).
Among the 4 studies, testicular torsion was identified via POC ultrasound in 205 patients although 3 of these were found to be false positives.
The pooled sensitivity was 98.4% (95% CI 88.5 – 99.8%) and the specificity was 97.2% (95% CI 87.2 – 99.4%). The overall false positive rate was 2.8% (95% CI 0.6 – 12.8) and the positive predictive value (i.e., the probability that an individual has the condition) was 84.9%.
Based on their analysis, the researched felt that POC ultrasound had the potential to allow clinicians to diagnose testicular torsion rapidly and safely. They added that children with a positive result should undergo immediate exploratory surgery. However, an important caveat from their analysis was how the quality of the available evidence was only moderate because of a high risk of bias and heterogeneity.
The authors concluded that although POC ultrasound appeared to be able to accurately diagnose testicular torsion, prior to implementing such as recommendation, prospective studies were required to clarify the accuracy of this imaging modality.
Mori T et al. Diagnostic accuracy of point-of-care ultrasound for paediatric testicular torsion: a systematic review and meta-analysis Emerg Med J 2022
25th February 2022
A hand-held carotid ultrasound device shows an acceptable level of agreement with conventional duplex ultrasound for the examination of patients with suspected transitory ischaemic attack (TIA) or ischaemic stroke. This was the conclusion by a team of researchers from the Department of Internal Medicine, Levanger Hospital, Norway.
According to the World Stroke Organisation, 1 in 4 adults over the age of 25 will have a stroke in their lifetime and in 2019, there were 12·2 million incident cases of strokes, accounting for 11.6% of all global deaths. Moreover, the presence of narrowing of the carotid artery or carotid stenosis, has been found to be associated with increased risk of ischaemic stroke. Carotid endarterectomy as a treatment, has been found to be of some benefit for patients with 50% to 69% symptomatic stenosis, in reducing the risk of stroke. However, carotid stenosis cannot be adequately assessed through a physical examination and carotid ultrasonography has become a reproducible imaging method used to detect carotid atherosclerosis.
But could a hand-held carotid and hence much more portable, ultrasound device be just as reliable for the examination of patients with suspected TIA or an ischaemic stroke compared to a conventional high-end vascular ultrasound (HIGH)? This was the essential question addressed in the current study by the Norwegian team. They included patients admitted to a community hospital with a suspected stroke or transient ischaemic attack. The patients were examined using a hand-held carotid ultrasound and the severity of carotid stenosis graded on a 7-point ordinal scale from 1 (normal) to 7 (occluded). Following this initial assessment, a HIGH was performed by a second cardiologist who remained unaware of the findings from the hand-held device and graded the degree of stenosis using the same scale. The results of the two scans were then compared by weighted Cohen’s Kappa and which is designed to assess the level of agreement between the two techniques. Scores range from 0 to 1 with 0.41 – 0.60 rated as moderate agreement, 0.61 – 0.80 as substantial and over 0.81 as almost perfect agreement.
Hand-held carotid ultrasound agreement with HIGH
A total of 80 patients with a mean age of 71.5 years (47.5% women) were included in the study, 27.5% of whom, had a previous history of cardiovascular ischaemic events (i.e., ischaemic stroke, TIA, or myocardial infarction). From the total cohort, 11% were found to have a greater than 50% internal carotid stenosis (ICS) on examination. Overall, 77.5% of patients were discharged with a diagnosis of ischaemic stroke or TIA.
The overall agreement between the hand-held device and HIGH for the classification of the degree of internal carotid stenosis was 69%. In addition, the weighted Kappa agreement between the hand-held device and HIGH was 0.76 (95% CI 0.66 – 0.85). Nevertheless, there was evidence that the hand-held device overestimated ICS compared to HIGH when there was >50% occlusion (odds ratio for agreement = 0.15, 95% CI 0.06 – 0.42) using < 50% stenosis as the reference.
In discussing their results, the authors stated that there was a strong correlation between ICS grading between the hand-held carotid device and HIGH. They concluded that examining the level of carotid stenosis with a hand-held device was a reliable method for ruling out significant carotid artery disease. But given the potential for overestimation when the carotid stenosis was greater than 50%, the authors suggested that the hand-device device should not be used for detailed classification of carotid disease.
Saxhaug LM et al. Reliability and agreement of point-of-care carotid artery examinations by experts using hand-held ultrasound devices in patients with ischaemic stroke or transitory ischaemic attack Open Heart 2022
7th January 2022
The use of a point-of-care (POC) COVID-19 test within an emergency department (ED) has been found to significantly reduce the turn-around- time compared to PCR tests among patients in need of hospital treatment. This was the key finding of an analysis by a team from the Department of Emergency and Acute Medicine, Charite Universitatsmedizin, Berlin, Germany.
The COVID-19 pandemic has placed enormous strain on healthcare systems across the globe and this has been particularly true for emergency departments (EDs) since patients, even with mild symptoms tend to intuitively present at an ED when they believe they have a serious disease. An ED therefore requires access to a fast and accurate means of testing patients for COVID-19 when they present at the department. The gold standard test for COVID-19 is a PCR test although results are not available for between 4 and 24 hours . The use of rapid antigen tests offers a potentially faster alternative but research has shown that while these tests are useful for symptomatic patients in the emergency setting, patients testing negative require confirmation by PCR test and should isolate until this result becomes available.
With a need for a rapid COVID-19 test result among all patients potentially requiring urgent inpatient care, for the present study, the German team set out to evaluate the role of a POC COVID-19 test for use in the ED. All inpatients were routinely screened at the researcher’s hospital for COVID-19 and they retrospectively examined the clinical characteristics and in-hospital follow-up data for all patients from the electronic medical records. For the study, the team set the primary outcome measure as the turn-around-time (TAT) for the POC compared to the standard PCR test result as well as examining the diagnostic performance of the device which was integrated with the hospital LAN system and ordered via the laboratory channel and ED.
A population of 160 patients with a mean age of 68 years (69% female) were included and of whom, 16 tested positive for COVID-19 using the POC. The most common symptoms of COVID-19 were dyspnoea (37.5%), fever and cough (both 25%).
The POC had a sensitivity and specificity of 100% and the test result was available within a median of 102 minutes after admission compared to a median of 811 minutes for the PCR test (p < 0.001). Among patients requiring an intervention within 6 hours of presentation (e.g., severe trauma, myocardial infarction), the POC test result was available before the intervention in 92.1% of patients compared to only 5.4% of those with a PCR test result.
The authors concluded that the device could be easily incorporated into an ED and that it showed a high diagnostic performance.
Mockel M et al. SARS-CoV-2 screening in patients in need of urgent inpatient treatment in the Emergency Department (ED) by digitally integrated point-of-care PCR: a clinical cohort study. MedRxiv 2022