Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Sep 11;16(1):14.
doi: 10.1186/s12947-018-0132-0.

When to incorporate point-of-care ultrasound (POCUS) into the initial assessment of acutely ill patients: a pilot crossover study to compare 2 POCUS-assisted simulation protocols

Courtney E Bennett  1 , Sandhya Samavedam  2   3 , Namita Jayaprakash  2   4 , Alexander Kogan  5   6   7 , Ognjen Gajic  2   8 , Hiroshi Sekiguchi  2
Affiliations
Randomized Controlled Trial

When to incorporate point-of-care ultrasound (POCUS) into the initial assessment of acutely ill patients: a pilot crossover study to compare 2 POCUS-assisted simulation protocols

Courtney E Bennett et al. Cardiovasc Ultrasound. .

Abstract

Background: The purpose of this study was to determine the ideal timing for providers to perform point-of-care ultrasound (POCUS) with the least increase in workload.

Methods: We conducted a pilot crossover study to compare 2 POCUS-assisted evaluation protocols for acutely ill patients: sequential (physical examination followed by POCUS) vs parallel (POCUS at the time of physical examination). Participants were randomly assigned to 2 groups according to which POCUS-assisted protocol (sequential vs parallel) was used during simulated scenarios. Subsequently, the groups were crossed over to complete assessment by using the other POCUS-assisted protocol in the same patient scenarios. Providers' workloads, measured with the National Aeronautics and Space Administration Task Load Index (NASA-TLX) and time to complete patient evaluation, were compared between the 2 protocols.

Results: Seven providers completed 14 assessments (7 sequential and 7 parallel). The median (IQR) total NASA-TLX score was 30 (30-50) in the sequential and 55 (50-65) in the parallel protocol (P = .03), which suggests a significantly lower workload in the sequential protocol. When individual components of the NASA-TLX score were evaluated, mental demand and frustration level were significantly lower in the sequential than in the parallel protocol (40 [IQR, 30-60] vs 50 [IQR, 40-70]; P = .03 and 25 [IQR, 20-35] vs 60 [IQR, 45-85]; P = .02, respectively). The time needed to complete the assessment was similar between the sequential and parallel protocols (8.7 [IQR, 6-9] minutes vs 10.1 [IQR, 7-11] minutes, respectively; P = .30).

Conclusions: A sequential POCUS-assisted protocol posed less workload to POCUS operators than the parallel protocol.

Keywords: Critical illness; Point-of-care; Simulation; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Mayo Clinic Institutional Review Board (12–007998).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowcharts Showing the Sequential and Parallel POCUS Protocols. a, In the sequential protocol, the ABCDE (airway, breathing, circulation, disability, and exposure [and vasculature*]) evaluations are completed, and then the system-specific POCUS examinations are performed. b, In the parallel protocol, the airway and breathing assessments are completed, followed by the thoracic POCUS; then the circulation assessment, followed by cardiac POCUS; then the disability and exposure assessments, followed by the abdominal POCUS and vasculature* (venous) POCUS. POCUS indicates point-of-care ultrasound. * indicates addition to the ABCDE evaluation
See this image and copyright information in PMC

References

    1. Ferrada P, Vanguri P, Anand RJ, Whelan J, Duane T, Aboutanos M, Malhotra A, Ivatury R. A, B, C, D, echo: limited transthoracic echocardiogram is a useful tool to guide therapy for hypotension in the trauma bay--a pilot study. J Trauma Acute Care Surg. 2013;74(1):220–223. doi: 10.1097/TA.0b013e318278918a. - DOI - PubMed
    1. Hollister N, Bond R, Donovan A, Nicholls B. Saved by focused echo evaluation in resuscitation. Emerg Med J. 2011;28(11):986–989. doi: 10.1136/emj.11.2010.3490rep. - DOI - PubMed
    1. Gunst M, Sperry J, Ghaemmaghami V, O'Keeffe T, Friese R, Frankel H. Bedside echocardiographic assessment for trauma/critical care: the BEAT exam. J Am Coll Surg. 2008;207(3):e1–e3. doi: 10.1016/j.jamcollsurg.2008.05.027. - DOI - PubMed
    1. Pershad J, Myers S, Plouman C, Rosson C, Elam K, Wan J, Chin T. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics. 2004;114(6):e667–e671. doi: 10.1542/peds.2004-0881. - DOI - PubMed
    1. Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16. doi: 10.1186/1476-7120-6-16. - DOI - PMC - PubMed

Publication types

LinkOut - more resources