Multi-organ clinical ultrasound as a complement to the diagnostic process in an internal medicine consultation.

INTRODUCTION: Evaluating outpatient cases in internal medicine consultations presents a significant diagnostic challenge. Ultrasound can be a highly useful tool in assessment and decision-making. PATIENTS AND METHODS: A prospective observational study was conducted on a cohort of patients attending an internal medicine rapid assessment clinic. Eighty patients were prospectively recruited. A medical consultation was conducted as per usual clinical practice, followed by a POCUS evaluation; collecting pulmonary, cardiac, and abdominal data. All findings were analyzed and recorded, particularly those that were significant or altered the initial diagnosis, subsequent tests, or treatment. RESULTS: Significant ultrasound findings were found in 37.5% of the patients. Of all ultrasound scans, the most clinically relevant were in the heart region (31.9%), followed by the abdomen (26%). These findings led to a change in overall management in 27.5% of patients. Using logistic regression, a model was developed to estimate the presence of clinically relevant findings with an area under the curve (AUC) of 0.78 (95% CI 0.66-0.89; p < 0.001) with 80% Sensitivity and 66% Specificity. CONCLUSION: The systematic and standardized incorporation of clinical ultrasound in internal medicine consultations contributes to decision-making, can provide significant findings that allow for modifications in clinical suspicion and therapeutic management.

The role of lung ultrasonography in the SARS-CoV-2 vaccines and variants era: a case report.

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The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

Purpose: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. Material and methods: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. Results: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70 mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p < 0.001]. Conclusions: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

Objetivo: Existe una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje.El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU). Material y métodos: Estudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio. Resultados: Se inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 mg/L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p < 0,001] para dicho modelo predictivo, en materia de mortalidad. Conclusiones: La combinación de LUS, hallazgos clínicos y de laboratorio en esta «regla de 7¼ de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad.

The lung ultrasound “Rule of 7” in the prognosis of COVID-19 patients: Results from a prospective multicentric study

PurposeThere is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored.To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge.Material and methodsProspective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests.ResultsA total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation – SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p<0.001].ConclusionsThe combination of LUS, clinical and laboratory findings in this easy to apply “rule of 7” showed excellent performance to predict hospital admission and mortality. (AU)

ObjetivoExiste una evidencia creciente con respecto a los hallazgos de imagen de la enfermedad por coronavirus 2019 (COVID-19) en la ecografía pulmonar (LUS), sin embargo, aún no se ha explorado el uso de una herramienta combinada de pronóstico y triaje.El objetivo principal de este estudio fue determinar el impacto de la LUS en la predicción de la mortalidad de los pacientes con sospecha de afectación pulmonar por COVID-19. El objetivo secundario fue calcular una puntuación con los hallazgos del LUS con otras variables para predecir el ingreso hospitalario y el alta del servicio de urgencias (SU).Material y métodosEstudio prospectivo realizado en urgencias de tres hospitales académicos, en pacientes con sospecha de COVID-19 o confirmación de esta, a los que se sometió a un examen de LUS y pruebas de laboratorio.ResultadosSe inscribieron un total de 228 pacientes entre marzo y septiembre de 2020. La edad media fue de 61,9 años (DE 21,1). El hallazgo más común en la LUS fue la irregularidad pleural posteroinferior derecha (53,9%, 123 pacientes). Se calculó un modelo de regresión logística, que incluyó la edad mayor de 70 años, proteína C reactiva (PCR) mayor de 70 mg/L y puntuación de afectación pulmonar mediante LUS score superior a 7 para predecir la mortalidad, el ingreso hospitalario y el alta del SU. Se obtuvo una sensibilidad del 56,8% y una especificidad del 87,6%, con un AUC de 0,813 [p < 0,001] para dicho modelo predictivo, en materia de mortalidad.ConclusionesLa combinación de LUS, hallazgos clínicos y de laboratorio en esta «regla de 7» de fácil aplicación se mostró de utilidad para predecir el ingreso hospitalario y la mortalidad. (AU)

The lung ultrasound "Rule of 7" in the prognosis of COVID-19 patients: Results from a prospective multicentric study.

PURPOSE: There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasound (LUS), however the use of a combined prognostic and triage tool has yet to be explored. To determine the impact of the LUS in the prediction of the mortality of patients with highly suspected or confirmed COVID-19.The secondary outcome was to calculate a score with LUS findings with other variables to predict hospital admission and emergency department (ED) discharge. MATERIAL AND METHODS: Prospective study performed in the ED of three academic hospitals. Patients with highly suspected or confirmed COVID-19 underwent a LUS examination and laboratory tests. RESULTS: A total of 228 patients were enrolled between March and September 2020. The mean age was 61.9 years (Standard Deviation - SD 21.1). The most common findings in LUS was a right posteroinferior isolated irregular pleural line (53.9%, 123 patients). A logistic regression model was calculated, including age over 70 years, C-reactive protein (CRP) over 70mg/L and a lung score over 7 to predict mortality, hospital admission and discharge from the ED. We obtained a predictive model with a sensitivity of 56.8% and a specificity of 87.6%, with an AUC of 0.813 [p<0.001]. CONCLUSIONS: The combination of LUS, clinical and laboratory findings in this easy to apply "rule of 7" showed excellent performance to predict hospital admission and mortality.

The use of ultrasound in the emergency department for the detection of thoracic outlet syndrome: A single case study.

INTRODUCTION: Thoracic outlet syndrome (TOS) refers to a spectrum of syndromes related to the compression of the brachial plexus (neurogenic TOS), subclavian vein or artery in the general region of the thoracic outlet, which is the area just above the first rib and behind the clavicle. CASE REPORT: We report a 27-year-old healthy man who presented to the emergency department with right upper limb pain, tingling and weakness. Point-of-care ultrasonography was performed following a dynamic protocol in the supraclavicular fossa in the right upper limb. A congenital cervical rib, as well as narrowing of the costoclavicular gap, causing vein, artery and spinal roots compression was evidenced. This maneuver reproduced the symptoms, confirming the suspicion of neurogenic TOS. DISCUSSION: Early diagnosis is important, because the neurogenic compression associated with neurogenic TOS, if prolonged, can lead to muscle weakness and atrophy, being irreversible. Selected patients with neurogenic TOS who have progressive weakness, disabling pain, or who have failed to improve with conservative measures are considered for first rib resection. CONCLUSION: Using the dynamic approach during point-of-care ultrasonography examination, in combination with physical examination and cervical radiography, could help identify neurogenic TOS.

Utilización de TICs en medicina de urgencias: valoración de un software de ayuda a la prescripción del paciente con hiperglucemia (DIAGETHER(R)), por parte de médicos residentes / Use of ICTs in emergency medicine: assessment of a prescription aid software for patients with hyperglycemia (DIAGETHER(R)), by resident doctors

INTRODUCCIÓN: La permisividad ante la hiperglucemia es nociva para los pacientes ingresados. DIAGETHER es una aplicación que ayuda al médico en el tratamiento del paciente diabético. OBJETIVOS: Determinar grado de usabilidad, nivel de confianza y valoración global de DIAGETHER empleada por médicos residentes en distintos escenarios clínicos. MÉTODO: Estudio descriptivo multicéntrico, basado en una encuesta de valoración sobre DIAGETHER, a 42 residentes de dos hospitales, valorando la toma de decisiones con respecto a la terapéutica de pacientes con alteraciones glucémicas en distintos escenarios clínicos. RESULTADOS: DIAGETHER fue valorado positivamente respecto a usabilidad, confianza en resolución de casos, y tiempo empleado. La valoración global de la herramienta fue del 87,5. En el lado negativo, es necesario realizar estudios en terreno real para saber la adaptación real de la herramienta al trabajo médico. CONCLUSIONES: La aplicación DIAGETHER(R) es una herramienta fácil de usar, rápida en la toma de decisiones y le da al médico seguridad en el tratamiento de pacientes con hiperglucemia, lo que hace que su valoración global sea alta. En el lado negativo, el estudio fue realizado en condiciones "no reales", sería interesante desarrollar futuros estudio en varios servicios de urgencias

INTRODUCTION: Permissiveness to hyperglycemia is harmful to admitted patients. DIAGETHER is an application that helps the doctor in the treatment of the diabetic patient. OBJECTIVES: Determine degree of usability, level of confidence and overall assessment of DIAGETHER used by physicians resident in different clinical settings. Method. Multicenter descriptive study, based on a DIAGETHER assessment survey, of 42 residents of two hospitals, assessing decision-making regarding the therapeutics of patients with glycemic disorders in different clinical settings. RESULTS: DIAGETHER was positively assessed regarding usability, confidence in case resolution, and time spent. The overall assessment of the tool was 87.5. On the negative side, it is necessary to conduct real-field studies to know the real adaptation of the tool to medical work. CONCLUSIONS: The DIAGETHER(R) application is an easy-to-use, quick decision-making tool and gives the doctor safety in the treatment of patients with hyperglycemia, which makes their overall assessment high. On the negative side, the study was conducted under "non-real" conditions, it would be interesting to develop future studies in several emergency departments

Cambios evolutivos pulmonares en la ecografía torácica en pacientes con COVID-19 / Time course of lung changes on thoracic ultrasound of mild COVID-19 patients

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