Browsing by Author "Amatya, Yogendra"

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    Bedside lung ultrasound for the diagnosis of pneumonia in children presenting to an emergency department in a resource-limited setting
    (BMC, 2023-01-09) Amatya, Yogendra; Russell, Frances M.; Rijal, Suraj; Adhikari, Sunil; Nti, Benjamin; House, Darlene R.; Emergency Medicine, School of Medicine
    Background: Lung ultrasound (LUS) is an effective tool for diagnosing pneumonia; however, this has not been well studied in resource-limited settings where pneumonia is the leading cause of death in children under 5 years of age. Objective: The objective of this study was to evaluate the diagnostic accuracy of bedside LUS for diagnosis of pneumonia in children presenting to an emergency department (ED) in a resource-limited setting. Methods: This was a prospective cross-sectional study of children presenting to an ED with respiratory complaints conducted in Nepal. We included all children under 5 years of age with cough, fever, or difficulty breathing who received a chest radiograph. A bedside LUS was performed and interpreted by the treating clinician on all children prior to chest radiograph. The criterion standard was radiographic pneumonia, diagnosed by a panel of radiologists using the Chest Radiography in Epidemiological Studies methodology. The primary outcome was sensitivity and specificity of LUS for the diagnosis of pneumonia. All LUS images were later reviewed and interpreted by a blinded expert sonographer. Results: Three hundred and sixty-six children were enrolled in the study. The median age was 16.5 months (IQR 22) and 57.3% were male. Eighty-four patients (23%) were diagnosed with pneumonia by chest X-ray. Sensitivity, specificity, positive and negative likelihood ratios for clinician's LUS interpretation was 89.3% (95% CI 81-95), 86.1% (95%CI 82-90), 6.4, and 0.12 respectively. LUS demonstrated good diagnostic accuracy for pneumonia with an area under the curve of 0.88 (95% CI 0.83-0.92). Interrater agreement between clinician and expert ultrasound interpretation was excellent (k = 0.85). Conclusion: Bedside LUS when used by ED clinicians had good accuracy for diagnosis of pneumonia in children in a resource-limited setting.
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    Clinical Prediction Models for Pneumonia in Children Presenting to an Emergency Department in a Resource-Limited Setting Using Lung Ultrasound Diagnosis as the Gold Standard
    (Springer Nature, 2025-03-28) House, Darlene R.; Amatya, Yogendra; Nti, Benjamin K.; Russell, Frances M.; Emergency Medicine, School of Medicine
    Introduction: Clinical prediction rules for pediatric pneumonia often rely on radiographic pneumonia for diagnosis; however, lung ultrasound has higher diagnostic accuracy. Our objective was to derive a clinical prediction model for pneumonia in children under five using lung ultrasound as the criterion standard. Methods: This was a prospective study of children under five presenting to an emergency department (ED) with respiratory complaints in a resource-limited setting. Clinical findings, chest X-ray, and lung ultrasound results were recorded for each patient. Classification tree models were used to predict pneumonia using lung ultrasound as the criterion standard. Separate models were used without and with inclusion of chest X-ray results. Results: Of 386 patients enrolled, 125 patients (32.4%) had pneumonia on lung ultrasound. The mean age was 20.8 (SD 15.5) months. Using recursive feature selection, three variables provided the best prediction for pneumonia, namely, crepitations, retractions, and difficulty breathing, demonstrating a sensitivity of 74.2% and specificity of 38.5%. The algorithm including chest X-ray provided a sensitivity of 51.6% and specificity of 87.7%. Conclusions: Using lung ultrasound as the gold standard, no single clinical finding or combination of clinical findings provided enough accuracy to reliably diagnose pneumonia in children under five years.
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    Establishing a Low-Resource Simulation Emergency Medicine Curriculum in Nepal
    (Association of American Medical Colleges, 2020-07-15) Wang, Alfred; Saltarelli, Nicholas; Cooper, Dylan; Amatya, Yogendra; House, Darlene R.; Emergency Medicine, School of Medicine
    Introduction High-fidelity medical simulation is widely used in emergency medicine training because it mirrors the fast-paced environment of the emergency department (ED). However, simulation is not common in emergency medicine training programs in lower-resourced countries as cost, availability of resources, and faculty experience are potential limitations. We initiated a simulation curriculum in a low-resource environment. Methods We created a simulation lab for medical officers and students on their emergency medicine rotation at a teaching hospital in Patan, Nepal, with 48,000 ED patient visits per year. We set up a simulation lab consisting of a room with one manikin, an intubation trainer, and a projector displaying a simulation cardiac monitor. In this environment, we ran a total of eight cases over 4 simulation days. Debriefing was done at the end of each case. At the end of the curriculum, an electronic survey was delivered to the medical officers to seek improvement for future cases. Results All eight cases were well received, and learners appreciated the safe learning space and teamwork. Of note, the first simulation case that was run (the airway lab) was more difficult for learners due to lack of experience. Survey feedback included improving the debriefing content and adding further procedural skills training. Discussion Simulation is a valuable experience for learners in any environment. Although resources may be limited abroad, a sustainable simulation lab can be constructed and pot
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    Impact of bedside lung ultrasound on physician clinical decision-making in an emergency department in Nepal
    (BMC, 2020) House, Darlene R.; Amatya, Yogendra; Nti, Benjamin; Russell, Frances M.; Emergency Medicine, School of Medicine
    Background Lung ultrasound is an effective tool for the evaluation of undifferentiated dyspnea in the emergency department. Impact of lung ultrasound on clinical decisions for the evaluation of patients with dyspnea in resource-limited settings is not well-known. The objective of this study was to evaluate the impact of lung ultrasound on clinical decision-making for patients presenting with dyspnea to an emergency department in the resource-limited setting of Nepal. Methods A prospective, cross-sectional study of clinicians working in the Patan Hospital Emergency Department was performed. Clinicians performed lung ultrasounds on patients presenting with dyspnea and submitted ultrasounds with their pre-test diagnosis, lung ultrasound interpretation, post-test diagnosis, and any change in management. Results Twenty-two clinicians participated in the study, completing 280 lung ultrasounds. Diagnosis changed in 124 (44.3%) of patients with dyspnea. Clinicians reported a change in management based on the lung ultrasound in 150 cases (53.6%). Of the changes in management, the majority involved treatment (83.3%) followed by disposition (13.3%) and new consults (2.7%). Conclusions In an emergency department in Nepal, bedside lung ultrasound had a significant impact on physician clinical decision-making, especially on patient diagnosis and treatment.
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    Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting
    (Springer, 2021-06-30) House, Darlene R.; Amatya, Yogendra; Nti, Benjamin; Russell, Frances M.; Emergency Medicine, School of Medicine
    Background: Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea. Methods: A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training. Results: Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively. Conclusions: Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.