Maui Emergencies in Medicine Conference 2022 Abstracts

A Double-blinded Comparison of Low-cost Ultrasound Media: A Simulation and In-vivo Analysis Sasha Reid, Anthony Santarelli, Heesun Choi Kingman Regional Medical Center, Kingman, AZ, USA Introduction: Point-of-care ultrasound is a vital real-time diagnostic tool due to its portability, accuracy, and ease of use. A barrier to its widespread use is the cost of ultrasound gel (USG). Therefore, many resource-poor areas are left without viable alternatives for commercialized USG. The primary objective of this study was to determine the diagnostic image quality of low-cost and readily available USG alternatives. The secondary objective was to determine the clinical efficacy among diagnosticians of varying degrees of expertise. Methods: A volunteer was recruited to participate as a human model. Two diagnosticians (one fellowship trained and one resident physician) generated the views of the right upper quadrant, left upper quadrant, and gallbladder with USG and five household gel analogs (water, isopropyl alcohol, mineral oil, lotion, conditioner, and Aloe vera gel). The images then were imported into the ImageJ image processing software. Measures taken include the diameter of the anterior wall of the gallbladder, inferior point of the splenorenal recess, and inferior point of Morrison’s pouch. Image quality was assessed through the area of the image exhibiting the highest 25% of signal intensity. Data were assessed using the analysis of variance and Student’s t-tests. Results: The measured diameter of the anterior wall of the gallbladder significantly varied based upon gel analog (P = 0.008). Wherein, Aquasonic USG (x̅ = 0.45 cm, σ = 0.17 cm) outperformed isopropyl alcohol (x̅ = 0.29 cm, σ = 0.05 cm) (P = 0.010). No significant differences in the reliability of anatomical measurements were detected between the remaining gel analogs. The quality of image as defined by the field of view consists of the upper 25% signal intensity varied by diagnostician. Wherein the area of detectable signal was greater in the gallbladder view (30.9% vs. 24.2%; P = 0.004) and left upper quadrant (36.9% vs. 26.0%; P < 0.001), when produced by a fellowship trained diagnostician. Conclusion: There is no significant difference in the quality of image produced between USG media and many common household alternatives. Irrespective of the media used, fellowship trained diagnosticians regularly produces the scans of higher quality than an individual lacking dedicated training. The use of image analysis software for determining the diagnostic accuracy of novel ultrasound technologies should be further explored. Keywords: Image quality, low-cost ultrasound, ultrasound, ultrasound gel, ultrasound images Age and High-sensitivity Troponin Algorithm for Evaluating Possible Myocardial Infarction Brandon R. Allen, Richard M. Nowak1, James C. O’Neill2, Nicklaus P. Ashburn2, Anna C. Snavely2, Brennan E. Paradee2, Robert H. Christenson3, Bryn E. Mumma4, Troy Madsen5, Jason P. Stopyra2, Simon A. Mahler2 University of Florida, Gainesville, FL, 1Henry Ford Health System, Detroit, MI, 2Wake Forest University, Winston-Salem, NC, 3University of Maryland, Baltimore, MD, 4University of California, Davis, California, 5University of Utah, Salt Lake, Utah, USA Background: The European Society of Cardiology (ESC) 0/1-hour high-sensitivity troponin (hs-cTn) algorithm is used for evaluating patients presenting to the emergency department (ED) with symptoms suspicious for non-ST-segment elevation myocardial infarction (NSTEMI). The objective of this secondary analysis of the STOP-CP (High-sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) United States (US) multicenter study was to evaluate the safety and efficacy of the ESC 0/1-hour hs-cTnT algorithm by age. Methods: Patients (≥21 years old) presenting to the ED with symptoms suggestive of NSTEMI were enrolled at 8 US EDs. The ESC hs-cTnT 0/1-hour algorithm was used to place patients into rule-out, observe, and rule-in NSTEMI zones. Algorithm performance for rapid NSTEMI rule-out and 30-day adverse outcomes was studied in three age (years) intervals: younger (21–45), middle aged (46–64), and older (≥65). Major adverse cardiovascular events (MACEs) consisted of a cardiac death, myocardial infarction, or coronary revascularization at 30 days. Fisher’s exact tests were used to compare NSTEMI ruled out and MACE rates between patient age intervals. Negative likelihood ratios (NLR) with a 95% confidence interval (CI) were calculated for 30-day MACE. Results: Overall, 1430 participants were enrolled with 15.7% (224/1430) young, 57.4% (821/1430) middle-aged, and 26.9% (385/1430) being older. The ESC 0/1 h-cTnT 0/-hour algorithm NSTEMI ruled out rates were 79.9% (179/224), 62.1% (510/821), and 35.6% (137/385) for these age groupings (P < 0.0001). The overall 30-day MACE rate was 14.2% (203/1430) with interval age rates of 16/224 (7.1%) younger, 108/821 (13.1%) middle aged, and 79/385 (20.5%) older patients. Among NSTEMI ruled-out patients, MACE occurred in 1.1% (2/179) of younger, 3.3% (17/510) middle aged, and 2.9% (4/137) of older individuals.(P = 0.320). NLR for 30-day MACE was 0.15 (95% CI: 0.04–0.54) in younger, 0.23 (95% CI: 0.15–0.35) middle aged, and 0.12 (95% CI: 0.04-0.31) older patients. Conclusion: With increasing age, patients were less likely to be rapidly ruled out for NSTEMI. Age interval alone was not an independent variable that added to the risk stratification of this patient group for 30-day MACE. Our report suggests that currently used cardiac risk stratification scores using age as a variable for 30-day MACE in rapidly ruled-out NSTEMI patients require reevaluation. Keywords: Age, chest pain, high-sensitivity troponin, major adverse cardiovascular event, myocardial infarction, non-ST-segment elevation myocardial infarction, troponin Perceptions of an Aseptic Touch-free Disposable Stethoscope Barrier Lee Anne Siegmund, W. Frank Peacock1, James F. Bena2, Shannon L. Morrison2 Cleveland Clinic Nursing Research and Innovation, 2Cleveland Clinic Quantitative Health Science, Cleveland, Ohio, 1Baylor College of Medicine, Houston, TX, USA Background: Hand washing is an accepted practice for preventing hospital-acquired infections; however, stethoscope hygiene is rarely performed despite that stethoscopes carry a similar bacterial load compared to hands. When cleaned for 60 s (Centers for Disease Control and Prevention recommended) with alcohol, stethoscopes sometimes remain contaminated with pathogens, while touch-free barriers were shown to provide bacteriologically impervious surfaces. The purpose of this study is to determine patients’ and nurses/providers’ perceptions of ease of use, compliance, and patient safety when comparing touch-free stethoscope diaphragm barriers, alcohol, or no cleaning. Methods: Patients and nurses/providers viewed videos comparing three stethoscope hygiene techniques (touch-free barrier, alcohol for 60 s, or no cleaning) followed by a survey. Pairwise comparisons and Bonferroni correction were calculated. Wilcoxon rank tests assessed if responses differed from the midpoint. Alpha was 0.05. Results: Patients (n = 119) witnessed providers cleaning their stethoscope “sometimes” or “not sure” and when asked their opinion of cleaning or barriers, barriers were rated as equal or superior to alcohol. Nurses/providers (n = 121) said that they cleaned between patients “most” or “always,” were more likely to choose “significantly or slightly improve” compliance over “significantly or slightly worsen” stethoscope hygiene compliance (P < 0.001). Both groups responded stethoscope hygiene was important, barriers would be easiest to use or positively impact workflow (P < 0.001), and alcohol was superior to touch-free barrier for patient safety (P < 0.001). Conclusion: Participants perceived alcohol as superior to touch-free barriers for patient safety, which contradicts prior data that touch-free barriers were 100% effective for reducing pathogen transmission. Thus, there is a unique disparity between perception and reality that the clinical world needs to address. Results should be interpreted within the context of the likelihood providers would adequately clean their stethoscope. Touch-free barriers may provide optimal patient safety given perceptions of Keywords: Disposable stethoscope barrier, stethoscope touch-free barrier, touch-free stethoscope of Image to the of Point-of-care Ultrasound of and and University of California, of Medicine, of Medicine, of Medicine, University of California, University of Center, Houston, TX, USA Background: Point-of-care ultrasound a in evaluating in the emergency department The rapid and of a and using to and however, is the and of at Methods: performed a of ED patients and as the of their for at ED from to and out of for the The primary analysis at the of ED to Results: The images were to an overall of (95% confidence interval of (95% CI: of (95% CI: and of (95% CI: with a of a of (95% CI: of 95% (95% CI: of (95% CI: and of (95% CI: with a of a of (95% CI: of (95% CI: of (95% CI: and of (95% CI: with a a of (95% CI: of (95% CI: of (95% CI: and of (95% CI: The secondary analysis at further by and Conclusion: a of for as compared to and are and for Overall, the use of for to without is an effective tool for in and may be in Keywords: ultrasound, ultrasound, for in Point-of-care Ultrasound of Medicine, University of California, of Medicine, of Medicine, of Medicine, University of California, University of Center, Houston, TX, USA Background: shown that ultrasound the clinical to that with the use of should into which would likely in further clinical outcomes for patients. the impact patient there are barriers to use to determine if there was with the workflow and determine the in from the in data Methods: A workflow was which (ED) patient into the to their use of the workflow was through The of and was and calculated. Results: There was a for the with of to be more to use than the workflow and of to be to use compared to the in a in an data Conclusion: and is over data for workflow among the rate of data to patient was significantly using an A in for quality and Keywords: ultrasound, quality ultrasound in Disease of Medicine, University of California, of Medicine, of Medicine, of Medicine, University of California, of Medicine, University of Center, Houston, TX, USA Background: ultrasound in the of patients include or and is ultrasound that from The for the in of chest Point-of-care ultrasound the as and over the use of study to the accuracy of in with Methods: patients were enrolled in this study in the emergency department (ED) of a University Patients presenting with and were and enrolled in this A performed a to the The accuracy of the was compared to Results: A of patients were in the analysis and age of age for and detected in these patients with a of (95% confidence interval and of (95% CI: a of (95% CI: and a of (95% The common were the and to in patients Conclusion: the to be an effective tool for in the of be to Keywords: ultrasound, ultrasound, with in M. and Center, University of Medicine, Medical Center, Detroit, MI, USA Background: is a and used in and not for human use. is a that and and detected as an in the use may at risk of A of in a in Methods: was a of a of of with from to in Data and and of Results: of were The age was years with the were and by the The of was detected and more than and A was used to and a between and = detected and detected Conclusion: in The between and suggests that is added to study the for more for Keywords: by A and Center, University of Medicine, Detroit, MI, Medical University, USA Background: alcohol measurements are not readily available in clinical the is used as an in the of a alcohol the many are by an with and Our objective was a of with an and for and at a University Methods: of was and clinical data of patients presenting with an and and from to Results: The of patients in this study (n = with and these patients, an The were in of and one in with and to and in one of the and of these were one patient a of the an while an The without an were and one was with in one and in Conclusion: The common of an was Our are with that and to be the common of an when a alcohol was Our of with and that an with an was with with a common Keywords: alcohol, alcohol of Medicine, University of Detroit, MI, USA Background: an of in The of for as the a resident that is The of this study is to determine the is not inferior for emergency resident when compared to a Methods: resident in at and emergency were for the were to participate in the study were if they not the the or the A not in the study the and the the in at the and at the to the were given a of to The group to the given to the The primary was in to The tests five which were given a of based A comparing the between and groups was (one of and = Results: The data were available for and out of There were and The difference in was and for the and in a difference between the groups of of the upper 95% confidence interval and the P = Conclusion: The study was to of a compared to The include the and may not optimal for the Keywords: resident of and in Medical Brandon M. University of Medicine, Detroit, MI, USA Background: is not into the United of of and confidence of using training. Methods: and data was through in a at a A by emergency was to A was an and The primary was in and training. The secondary outcomes the of confidence and in quality assessed by a Results: and were in the was and the a rate of was from P < 0.0001). of with the highest being P < in or in being in to a or an in confidence of (P < 0.0001). at confidence (P < 0.0001). Overall, of the was of the to be as an Our that are and confidence through Keywords: Major Cardiac Negative of Chest Pain Medical Center, TX, USA Our primary objective was to the risk of major adverse cardiac events (MACEs) at and a coronary and myocardial in to patients. Methods: were for for and risk of was and were in this a to MACE for patients the of coronary when risk to a to analysis was performed using and Results: at with a (95% confidence interval = MACE compared to (95% = of the (P = and an overall rate of (95% = at = a analysis a MACE of (95% = compared to (95% = for with = analysis of with no not difference in the MACE at = vs. = and = vs. = Patients presenting with chest a coronary < or myocardial in the be without further risk stratification if their and troponin are given MACE. Keywords: emergency chest pain, major adverse cardiac event, myocardial Major in Disease and Myocardial Infarction Richard M. James C. Nicklaus P. Anna C. Brennan E. Brandon R. Robert H. Christenson3, Bryn E. Mumma4, Troy Madsen5, Jason P. Simon A. Ford Health System, Detroit, MI, Forest University, Winston-Salem, NC, of Florida, Gainesville, FL, 3University of Maryland, Baltimore, MD, 4University of California, Davis, California, 5University of Utah, Salt Utah, USA Background: The European Society of Cardiology (ESC) 0/1-hour high-sensitivity troponin (hs-cTn) algorithm is used for evaluating patients presenting to the emergency department with symptoms suspicious for non-ST-segment elevation myocardial infarction (NSTEMI). There are data available using this algorithm comparing NSTEMI rule-out and 30-day major cardiac adverse rates in patients with and without coronary defined as prior myocardial infarction coronary revascularization or coronary Methods: Patients (≥21 years old) with symptoms suggestive of NSTEMI were enrolled in the STOP-CP (High-sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) study at 8 United States (US) The ESC 0/1 h-cTnT algorithm was used to patients into rule-out, observe, and rule-in zones. Algorithm performance for 30-day adverse outcomes was in patients with or without MACE consisted of cardiac death, MI, or Fisher’s exact tests were used to compare ruled out NSTEMI and 30-day MACE rates in patients with and without Negative likelihood ratios (NLR) with 95% confidence were calculated for 30 MACE. Results: Overall, 1430 patients were enrolled with and 14.2% (203/1430) 30-day MACE. the ESC 0/1-hour hs-cTnT of patients with were in the rule-out compared to without (P < 0.0001). Overall, patients with 30-day MACE compared to of without (P < 0.0001). among patients in the rule-out 30-day MACE occurred in of with and of without (P < 0.0001). NLR for 30-day MACE was (95% in patients with and (95% in without The STOP-CP study patients with were less rapidly ruled out for NSTEMI and higher 30-day MACE rates than without Patients with rapidly ruled out for NSTEMI a higher 30-day MACE rate compared to without Our report suggests that rapidly ruled out patients with require further if a cardiac risk stratification at a risk for 30-day MACE. Keywords: coronary high-sensitivity troponin, major adverse myocardial infarction Cardiac and in Robert of Medicine, University of Medicine, Detroit, MI, of Medicine, University of Medicine, USA Background: in cardiac and The these differences between and within a are that practice and outcomes significantly between in Methods: A patients by Medical to in Detroit, was Data from the Cardiac to were between and The analysis patients years or older that were not to coronary performance or and were between Results: and patients were into one of the in between and and were significantly (P < for age, to emergency department (ED) coronary and Patients with were younger = and a from to ED = Patients coronary were less likely to be = or = Patients coronary were more likely to = and be at compared to A = Patients were older = Patients were less likely to be at = = and = compared to A and less likely to coronary = and = Patients were less likely to be at compared to A = or = Patients were more likely to an = and be = Patients with < were more likely to coronary = and = Conclusion: and between in Keywords: cardiac coronary and Hand Robert University of Medicine, of and Research University, Detroit, MI, USA Background: The an for to and compare the in from to to from to Methods: A analysis of or to United States from to was compared to that from to were to from to Data age, and of clinical and significant outcomes or major or Results: There were in years the study an of The in years of age, occurred in the and were Among at a the not require by the with a in significant outcomes (P < 0.001). There were of the the in the at a significant one Conclusion: to remain a the an report may with quality and and Keywords: in an Anne of Medicine, Medical University, for Medical University, College of University, of University, USA Background: patients use in this are used to of the their in is and not is not within this and Methods: of the ED were enrolled in a study to to patients use in in were at and at were and using a analysis Results: the patient and of of to patients the impact of between and and of and to in the ED Conclusion: the of in the ED with many of with patients. barriers to the ED as a and to or be to and or to with patients use Keywords: Point-of-care Ultrasound as a to Heesun MD, of Medicine, University of California, of Medicine, of Medicine, of Medicine, University of California, of Medicine, of Medicine, Regional Medical Center, Kingman, AZ, USA Background: in the United and of and are for study if emergency in the emergency department (ED) using Methods: A performed by patients with performed ultrasound enrolled patients by and views of the to determine if the patient Data were then compared to the data from the for Results: A of patients were enrolled in the The of of enrolled patients was (95% CI: with a of (95% CI: and a of (95% CI: Conclusion: data that emergency performed ultrasound in the ED a and in the of among ED patients. study that ultrasound performed by emergency may as a tool for the of Keywords: ultrasound, ultrasound The of for in C. C. R. of and and University of Medicine, Detroit, MI, USA Introduction: into the of the to with the human to to the as of a to to a of Our was confidence and perceived in these Methods: common performed in the emergency department (ED) were into the chest and The and with The data were using Wilcoxon Results: A of in the in the in the chest and in the The confidence in the in the chest and (P < 0.0001). There was an in the perception of in (P < 0.0001). The in the an for in in the and chest (P < 0.0001). the a of out of and of out of participate in the and a and of out of the chest and Conclusion: common ED into the confidence in training. they the and use of their into a more for Keywords: A in University College of Medicine, MI, USA Background: is an defined by within the and is a as its rate is if not or A with a of to the emergency department (ED) for a to the right for a as as the patient was There was a area of the right the with to Results: was to and A ultrasound (US) was performed which and in the and of with the of was and taken to for a of right and The patient was with a an is a clinical is to a of and to the that to when with a US is readily available to the and as as to the with the highest however, US in as a the A be in patients to the of or if US is this is and of the the for this Conclusion: US is a of for and be by the to the as and are and should be used if US is and in patients. patients should be for Keywords: ultrasound, ultrasound of of Cardiac Ultrasound in Heesun of Medicine, University of California, of Medicine, of Medicine, of Medicine, University of California, of Medicine, of Medicine, University of Center, Houston, TX, of Medicine, Regional Medical Center, Kingman, AZ, USA Background: A cardiac ultrasound be used to determine the of a wall of a to be in of when the is be when a coronary is and the cardiac no and is to as a wall and be within the of coronary study to emergency the of coronary and its patients with myocardial infarction based Methods: patients presenting to the emergency with were and enrolled for the A then performed a cardiac the and with of the patients’ the and of a cardiac if The were compared to the cardiac The and of in a coronary were calculated using the software. Results: A of patients were in the Overall, the ultrasound and a of 100% and a of 100% in the of coronary of the of cardiac and of ultrasound in left anterior was and and of ultrasound in right was and Conclusion: the the of coronary using and and are not in the exact that is are to the of cardiac ultrasound in cardiac in patients presenting with Keywords: myocardial infarction, point of ultrasound, myocardial infarction, ultrasound to Optimize Data and Center, University of Medicine, Detroit, MI, for Data Background: data are into patient patient are to and of clinical data clinical data are in the patient in a in to for and from the Data between the patient and are Our objective was to evaluate adverse from using data that clinical data to data Methods: The was to a of evaluating the of adverse from between and Results: There were for The data from clinical using a an at the and at the or The with a as or The of the with are and of the Results: the a that at one or used a the a of were The was to of these the the was to at one in of the Conclusion: study to the of data by the between patient and be to of data and Keywords: data The of the Troponin W. Frank James L. Robert Brandon R. Simon A. College of Medicine, Houston, TX, University of 5University of Florida, Gainesville, FL, Forest University of Medicine, Winston-Salem, NC, The Background: The high-sensitivity Troponin is for use as an in the of myocardial Our primary objective is to the diagnostic accuracy in patients presenting with coronary Methods: The study patients at United States emergency years of with and no prior in this provide a and within of ED to < and to < = 60 and ED of Chest Pain scores are Patients without the may be enrolled if the is and with the remaining to and a be performed the 30 major adverse cardiac and be A with the and be used to the Results: is that the performance to within 8 at the point of Conclusion: study within of patient Keywords: Chest pain, emergency myocardial infarction, troponin, troponin