Browsing by Author "Russell, Frances"

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    Acute Heart Failure Risk Stratification in the Emergency Department: Are We There Yet?
    (Elsevier, 2018) Russell, Frances; Pang, Peter S.; Emergency Medicine, School of Medicine
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    Effect of a point-of-care ultrasound (POCUS) curriculum on emergency department soft tissue management
    (Springer, 2022-10-21) Nti, Benjamin K.; Phillips, Whitney; Sarmiento, Elisa; Russell, Frances; Emergency Medicine, School of Medicine
    Background: Pediatric emergency department (ED) visits for superficial skin and soft tissue infections (SSTI) have steadily been increasing and point-of-care ultrasound (POCUS) continues to be an effective modality to improve management and shorter ED length of stays (LOS). Objective: We sought to determine the impact of a soft tissue POCUS curriculum on POCUS utilization, ED LOS, and cost-effectiveness. Methods: This was a retrospective pre- and post-interventional study of pediatric patients aged 0 to 17 years. Patients presenting to ED with international classification of disease 9 or 10 code for abscess or cellulitis were included. Data were collected a year before and after curriculum implementation with a 1-year washout training period. Training included continuing medical education, greater than 25 quality assured examinations, and a post-test. We compared diagnostic imaging type, ED LOS, and mean charges in patients with SSTI. Results: We analyzed data on 119 total patients, 38 pre- and 81 post-intervention. We found a significant increase in the total number of POCUS examinations performed pre- to post-curriculum intervention, 26 vs. 59 (p = 0.0017). Mean total charges were significantly decreased from $3,762 (± 270) to $2,622 (± 158; p = 0.0009). There was a significant trend towards a decrease in average ED LOS 282 (standard error of mean [SEM] ± 19) vs 185 (± 13) minutes (p = 0.0001). Conclusions: Implementation of a soft tissue POCUS curriculum in a pediatric ED was associated with increased POCUS use, decreased LOS, and lower cost. These findings highlight the importance of POCUS education and implementation in the management of pediatric SSTI.
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    Prehospital Lung Ultrasound in Acute Heart Failure: Impact on Diagnosis and Treatment
    (2023-04-28) Tamhankar, Omkar; Russell, Frances; Supples, Michael; Liao, Mark; Finnegan, Patrick
    Background and Objectives Patients with acute heart failure (AHF) are commonly misdiagnosed and undertreated in the prehospital setting. These delays in diagnosis and treatment have a direct negative impact on patient outcomes. The goal of this study was to determine the diagnostic accuracy of AHF by paramedics with and without lung ultrasound (LUS). We also assessed LUS impact on rate of initiation and time to initiation of HF therapies in AHF patients with and without LUS performed. Methods This was a prospective, nonrandomized, interventional study on a consecutive sample of patients transported to the hospital by one emergency medical services agency. Adult patients (>18) with a chief complaint of dyspnea and at least one of the following: bilateral lower extremity edema, orthopnea, wheezing or rales on auscultation, respiratory rate >20 or oxygen saturation < 92% were included. LUS was performed when a paramedic trained in LUS was present and an US was available on the ambulance. LUS was defined as positive for AHF if both anterior-superior lung zones had >2 B-lines or bilateral B-lines were visualized on a 4-view protocol. Paramedic diagnosis with and without the use of LUS was compared to hospital discharge diagnosis using Fishers exact analysis. Kappa was used to determine LUS interpretation interrater reliability between paramedic and expert. HF therapy was defined as nitroglycerin prehospital and furosemide in the emergency department. Time to treatment was defined as paramedic initial patient contact time to the time treatment was administered. Results A total of 353 patients were enrolled from March to September 2022; 89 did not meet inclusion criteria. Of the 264 included patients 94 (35%) had AHF. Forty patients had a LUS performed. Sensitivity and specificity for AHF by paramedics was 23% (95% CI 0.14-0.34) and 97% (CI 0.92-0.99) without LUS and 71% (95% CI 0.44-0.88) and 96% (95% CI 0.76-0.99) with the use of LUS. In the 94 patients with AHF, 14% (11/77) received HF therapy prehospital without the use of LUS and 53% (9/17) with the use of LUS. LUS improved frequency of treatment by 39%. Median time to treatment was 19 minutes with LUS and 149 minutes without. Kappa for LUS interpretation was 0.79 (CI 0.6-0.98). Conclusion LUS improved paramedic sensitivity and accuracy for diagnosing AHF in the prehospital setting. LUS use led to higher rates of prehospital HF therapy initiation and significantly decreased time to treatment.