EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION

Abstract

Aims To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS).

Methods We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of “strongly agree” and “agree” on the Likert scale responses.

Findings and Recommendations One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3–5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6–8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10).

Conclusion These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings.

Zusammenfassung

Ziel Bewertung der Evidenz und Erstellung einer Zusammenfassung sowie von Empfehlungen für die häufigsten Herz- und Lungenanwendungen des Point-of-Care-Ultraschalls (PoCUS).

Methoden Wir überprüften 10 klinische Bereiche bzw. Fragen im Zusammenhang mit den häufigsten Herz- und Lungenanwendungen des PoCUS. Nach der Überprüfung der Evidenz wurden eine Zusammenfassung und eine Empfehlung erstellt, einschließlich der Zuordnung von Evidenzgraden („Level of Evidence“ LoE) und der Einstufung der Empfehlung, Bewertung, Entwicklung und Evaluierung (GRADE). Die Expert Review Group (ERG), bestehend aus 38 internationalen Experten, wurde aufgefordert, die für jede Fragestellung vorgelegte Evidenz zu überprüfen. Eine Zustimmung von über 75 % war erforderlich, um zum nächsten Teilbereich überzugehen. Anschließend überprüfte die ERG die Ergebnisse und gab den Grad der Zustimmung (mittels 5-stufiger Likert-Skala) bezüglich der Zusammenfassung und Empfehlung für jede Fragestellung an. Diese wurde anerkannt, wenn der Grad der Zustimmung – definiert als Summe der Antworten „stimme voll zu“ und „stimme zu“ auf der Likert-Skala – mehr als 75 % betrug.

Ergebnisse und Empfehlungen Bei einer Frage wurde ein starker Konsens bei einem zugeordneten LoE von 3 und einer schwachen GRADE-Empfehlung erzielt (Frage 1). Die übrigen 9 Fragen erzielten eine breite Zustimmung, wobei eine Frage einen LoE von 4 und eine schwache GRADE-Empfehlung erhielt (Frage 2), 3 Fragen erreichten einen LoE von 3 mit schwacher GRADE-Empfehlung (Fragen 3–5), 3 Fragen erreichten einen LoE von 3 mit starker GRADE-Empfehlung (Fragen 6–8) und die verbleibenden 2 Fragen erhielten einen LoE von 2 mit einer starken GRADE-Empfehlung (Fragen 9 und 10).

Schlussfolgerung Diese konsensbasierten Empfehlungen sollen die klinische Praxis unterstützen und Bereiche für weitere Forschung im Bereich des PoCUS in der Akutversorgung aufzeigen.

Key words

clinical practice guidelines - EFSUMB - POCUS - chest ultrasound - point-of-care ultrasound

Publication History

Received: 23 December 2021

Accepted: 07 June 2022

Article published online:
13 October 2022

• References

• 1 Jarman RD. Hocus PoCUS: introducing point-of-care ultrasound. Ultrasound 2011; 19: 2-2
• 2 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2017; 43: 49-58
• 3 Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2017; 69: e27-e54
• 4 Baribeau Y, Sharkey A, Chaudhary O. et al. Handheld Point-of-Care Ultrasound Probes: The New Generation of POCUS. J Cardiothorac Vasc Anesth 2020; 34: 3139-3145
• 5 Thavanathan RS, Woo MY, Hall G. The future is in your hands – Handheld ultrasound in the emergency department. Canadian Journal of Emergency Medicine 2020; 22: 742-744
• 6 Blaivas M, Brannam L, Theodoro D. Ultrasound image quality comparison between an inexpensive handheld emergency department (ED) ultrasound machine and a large mobile ED ultrasound system. Acad Emerg Med 2004; 11: 778-781
• 7 Frohlich E, Beller K, Muller R. et al. Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device. Ultraschall in Med 2020; 41: 308-316
• 8 Barreiros AP, Dong Y, Ignee A. et al. EchoScopy in scanning abdominal diseases; a prospective single center study. Med Ultrason 2019; 21: 8-15
• 9 Barreiros AP, Cui XW, Ignee A. et al. EchoScopy in scanning abdominal diseases: initial clinical experience. Z Gastroenterol 2014; 52: 269-275
• 10 Cormack CJ, Wald AM, Coombs PR. et al. Time to establish pillars in point-of-care ultrasound. Ultrasound Med Biol 2019; 45: S35
• 11 Kollmann C, Jenderka KV, Moran CM. et al. EFSUMB Clinical Safety Statement for Diagnostic Ultrasound – (2019 revision). Ultraschall in Med 2020; 41: 387-389
• 12 ECMUS – The Safety Committee of EFSUMB. Recommendations and Information about regulatory aspects related to the use of hand-held ultrasound devices 2019. https://efsumb.org/wp-content/uploads/2020/12/Recommendation-handheld-devices_2019.pdf (accessed May 1, 2021).
• 13 Nielsen MB, Cantisani V, Sidhu PS. et al. The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper. Ultraschall in Med 2019; 40: e1
• 14 Weile J, Brix J, Moellekaer AB. Is point-of-care ultrasound disruptive innovation? Formulating why POCUS is different from conventional comprehensive ultrasound. Crit Ultrasound J 2018; 10: 25
• 15 AIUM Practice Parameter for the Performance of Selected Ultrasound-Guided Procedures. J Ultrasound Med 2016; 35: 1-40
• 16 Atkinson P, Bowra J, Lambert M. et al. International Federation for Emergency Medicine point of care ultrasound curriculum. CJEM 2015; 17: 161-170
• 17 Smallwood N, Dachsel M, Matsa R. et al. Focused acute medicine ultrasound (FAMUS) – point of care ultrasound for the acute medical unit. Acute Med 2016; 15: 193-196
• 18 Wong A, Galarza L, Duska F. Critical Care Ultrasound: A Systematic Review of International Training Competencies and Program. Crit Care Med 2019; 47: e256-e262
• 19 Hoppmann RA, Rao VV, Poston MB. et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J 2011; 3: 1-12
• 20 Bahner DP, Royall NA. Advanced ultrasound training for fourth-year medical students: a novel training program at The Ohio State University College of Medicine. Acad Med 2013; 88: 206-213
• 21 Hoppmann RA, Rao VV, Bell F. et al. The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Crit Ultrasound J 2015; 7: 18
• 22 Shokoohi H, Boniface K, Kaviany P. et al. An Experiential Learning Model Facilitates Learning of Bedside Ultrasound by Preclinical Medical Students. J Surg Educ 2016; 73: 208-214
• 23 Ang J, Doyle B, Allen P. et al. Teaching bedside ultrasound to medical students. Clin Teach 2018; 15: 331-335
• 24 Wong CK, Hai J, Chan KYE. et al. Point-of-care ultrasound augments physical examination learning by undergraduate medical students. Postgrad Med J 2021; 97: 10-15
• 25 Jenssen C, Gilja OH, Serra AL. et al. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Policy Document Development Strategy – Clinical Practice Guidelines, Position Statements and Technological Reviews. Ultrasound Int Open 2019; 5: E2-E10
• 26 Moher D, Shamseer L, Clarke M. et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4: 1
• 27 Whiting PF, Rutjes AWS, Westwood ME. et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155: 529-536
• 28 Shea BJ, Reeves BC, Wells G. et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 2017; 358: j4008
• 29 Howick J, Chalmers I, Glasziou P. et al The 2011 Oxford CEBM evidence levels of evidence (introductory document). Oxford Center for Evidence Based Medicine 2011. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence
• 30 Neumann I, Santesso N, Akl EA. et al. A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach. J Clin Epidemiol 2016; 72: 45-55
• 31 Likert R. A technique for the measurement of attitudes. Archives of Psychology 1932; 22: 55
• 32 Alpert EA, Amit U, Guranda L. et al. Emergency department point-of-care ultrasonography improves time to pericardiocentesis for clinically significant effusions. Clin Exp Emerg Med 2017; 4: 128-132
• 33 Andersen GN, Graven T, Skjetne K. et al. Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents. J Ultrasound Med 2015; 34: 627-636
• 34 Atkinson PR, Milne J, Diegelmann L. et al. Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Ann Emerg Med 2018; 72: 478-489
• 35 Buhumaid RE, St-Cyr Bourque J, Shokoohi H. et al. Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. Am J Emerg Med 2019; 37: 298-303
• 36 Chardoli M, Heidari F, Rabiee H. et al. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest. Chin J Traumatol 2012; 15: 284-287
• 37 Dine SE, Soyuncu S, Dinc B. et al. The Effect of the Emergency Physicians’ Clinical Decision of Targeted Ultrasonography Application in Non-Traumatic Shock Patients. Hong Kong Journal of Emergency Medicine 2015; 22: 364-370
• 38 Hanson MG, Chan B. The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study. Ultrasound J 2021; 13: 2
• 39 Kobal SL, Liel-Cohen N, Shimony S. et al. Impact of Point-of-Care Ultrasound Examination on Triage of Patients With Suspected Cardiac Disease. Am J Cardiol 2016; 118: 1583-1587
• 40 Lapostolle F, Petrovic T, Lenoir G. et al. Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. Am J Emerg Med 2006; 24: 237-242
• 41 Laursen CB, Sloth E, Lambrechtsen J. et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest 2013; 144: 1868-1875
• 42 Laursen CB, Sloth E, Lassen AT. et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med 2014; 2: 638-646
• 43 Mancuso FJN, Siqueira VN, Moisés VA. et al. Focused cardiac ultrasound using a pocket-size device in the emergency room. Arq Bras Cardiol 2014; 103: 530-537
• 44 Mantuani D, Frazee BW, Fahimi J. et al. Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea. West J Emerg Med 2016; 17: 46-53
• 45 Plummer D, Brunette D, Asinger R. et al. Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med 1992; 21: 709-712
• 46 Pyo SY, Park GJ, Kim SC. et al. Impact of the modified SESAME ultrasound protocol implementation on patients with cardiac arrest in the emergency department. The American Journal of Emergency Medicine 2021; 43: 62-68 DOI: 10.1016/j.ajem.2021.01.028.
• 47 Rugolotto M, Chang CP, Hu B. et al. Clinical use of cardiac ultrasound performed with a hand-carried device in patients admitted for acute cardiac care. Am J Cardiol 2002; 90: 1040-1042
• 48 Sasmaz MI, Gungor F, Guven R. et al. Effect of Focused Bedside Ultrasonography in Hypotensive Patients on the Clinical Decision of Emergency Physicians. Emerg Med Int 2017; 2017: 6248687
• 49 Shokoohi H, Boniface KS, Pourmand A. et al. Bedside Ultrasound Reduces Diagnostic Uncertainty and Guides Resuscitation in Patients With Undifferentiated Hypotension. Crit Care Med 2015; 43: 2562-2569
• 50 Skjetne K, Graven T, Haugen BO. et al. Diagnostic influence of cardiovascular screening by pocket-size ultrasound in a cardiac unit. Eur J Echocardiogr 2011; 12: 737-743
• 51 Umuhire OF, Henry MB, Levine AC. et al. Impact of ultrasound on management for dyspnea presentations in a Rwandan emergency department. Ultrasound J 2019; 11: 18
• 52 Zanobetti M, Scorpiniti M, Gigli C. et al. Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED. Chest 2017; 151: 1295-1301
• 53 Pare JR, Liu R, Moore CL. et al. Emergency physician focused cardiac ultrasound improves diagnosis of ascending aortic dissection. Am J Emerg Med 2016; 34: 486-492
• 54 Israr S, Cook AD, Chapple KM. et al. Pulseless electrical activity following traumatic cardiac arrest: Sign of life or death?. Injury 2019; 50: 1507-1510
• 55 Atkinson PR, Beckett N, French J. et al. Does Point-of-care Ultrasound Use Impact Resuscitation Length, Rates of Intervention, and Clinical Outcomes During Cardiac Arrest? A Study from the Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED) Investigators. Cureus 2019; 11: e4456
• 56 Chua MT, Chan GW, Kuan WS. Reversible Causes in Cardiovascular Collapse at the Emergency Department Using Ultrasonography (REVIVE-US). Ann Acad Med Singapore 2017; 46: 310-316
• 57 Zengin S, Yavuz E, Al B. et al. Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest. Resuscitation 2016; 102: 105-109
• 58 Ozen C, Salcin E, Akoglu H. et al. Assessment of ventricular wall motion with focused echocardiography during cardiac arrest to predict survival. Turk J Emerg Med 2016; 16: 12-16
• 59 Kim HB, Suh JY, Choi JH. et al. Can serial focussed echocardiographic evaluation in life support (FEEL) predict resuscitation outcome or termination of resuscitation (TOR)? A pilot study. Resuscitation 2016; 101: 21-26
• 60 Gaspari R, Weekes A, Adhikari S. et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation 2016; 109: 33-39
• 61 Bolvardi E, Pouryaghobi SM, Farzane R. et al. The prognostic value of using ultrasonography in cardiac resuscitation of patients with cardiac arrest. Int J Biomed Sci 2016; 12: 110-114
• 62 Ferrada P, Wolfe L, Anand RJ. et al. Use of limited transthoracic echocardiography in patients with traumatic cardiac arrest decreases the rate of nontherapeutic thoracotomy and hospital costs. J Ultrasound Med 2014; 33: 1829-1832
• 63 Cebicci H, Salt O, Gurbuz S. et al. Benefit of cardiac sonography for estimating the early term survival of the cardiopulmonary arrest patients. Hippokratia 2014; 18: 125-129
• 64 Tomruk O, Erdur B, Cetin G. et al. Assessment of cardiac ultrasonography in predicting outcome in adult cardiac arrest. J Int Med Res 2012; 40: 804-809
• 65 Cureton EL, Yeung LY, Kwan RO. et al. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. J Trauma Acute Care Surg 2012; 73: 102-110
• 66 Aichinger G, Zechner PM, Prause G. et al. Cardiac movement identified on prehospital echocardiography predicts outcome in cardiac arrest patients. Prehosp Emerg Care 2012; 16: 251-255
• 67 Hayhurst C, Lebus C, Atkinson PR. et al. An evaluation of echo in life support (ELS): is it feasible? What does it add?. Emerg Med J 2011; 28: 119-121
• 68 Breitkreutz R, Price S, Steiger HV. et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 2010; 81: 1527-1533
• 69 Salen P, Melniker L, Chooljian C. et al. Does the presence or absence of sonographically identified cardiac activity predict resuscitation outcomes of cardiac arrest patients?. Am J Emerg Med 2005; 23: 459-462
• 70 Salen P, O’Connor R, Sierzenski P. et al. Can cardiac sonography and capnography be used independently and in combination to predict resuscitation outcomes?. Acad Emerg Med 2001; 8: 610-615
• 71 Blaivas M, Fox JC. Outcome in cardiac arrest patients found to have cardiac standstill on the bedside emergency department echocardiogram. Acad Emerg Med 2001; 8: 616-621
• 72 Lalande E, Burwash-Brennan T, Burns K. et al. Is point-of-care ultrasound a reliable predictor of outcome during atraumatic, non-shockable cardiac arrest? A systematic review and meta-analysis from the SHoC investigators. Resuscitation 2019; 139: 159-166
• 73 Tsou PY, Kurbedin J, Chen YS. et al. Accuracy of point-of-care focused echocardiography in predicting outcome of resuscitation in cardiac arrest patients: A systematic review and meta-analysis. Resuscitation 2017; 114: 92-99
• 74 Blyth L, Atkinson P, Gadd K. et al. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med 2012; 19: 1119-1126
• 75 Moore CL, Rose GA, Tayal VS. et al. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med 2002; 9: 186-193
• 76 Randazzo MR, Snoey ER, Levitt MA. et al. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med 2003; 10: 973-977
• 77 Secko MA, Lazar JM, Salciccioli LA. et al. Can junior emergency physicians use E-point septal separation to accurately estimate left ventricular function in acutely dyspneic patients?. Acad Emerg Med 2011; 18: 1223-1226
• 78 Weekes AJ, Tassone HM, Babcock A. et al. Comparison of serial qualitative and quantitative assessments of caval index and left ventricular systolic function during early fluid resuscitation of hypotensive emergency department patients. Acad Emerg Med 2011; 18: 912-921
• 79 Dinh VA, Ko HS, Rao R. et al. Measuring cardiac index with a focused cardiac ultrasound examination in the ED. Am J Emerg Med 2012; 30: 1845-1851
• 80 Bustam A, Noor Azhar M, Singh Veriah R. et al. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J 2014; 31: 369-373
• 81 McKaigney CJ, Krantz MJ, La Rocque CL. et al. E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction. Am J Emerg Med 2014; 32: 493-497
• 82 Unluer EE, Karagoz A, Akoglu H. et al. Visual estimation of bedside echocardiographic ejection fraction by emergency physicians. West J Emerg Med 2014; 15: 221-226
• 83 Farsi D, Hajsadeghi S, Hajighanbari MJ. et al. Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases. J Ultrasound 2017; 20: 133-138
• 84 Balderston JR, Gertz ZM, Brooks S. et al. Diagnostic Yield and Accuracy of Bedside Echocardiography in the Emergency Department in Hemodynamically Stable Patients. J Ultrasound Med 2019; 38: 2845-2851
• 85 Ahn JH, Jeon J, Toh HC. et al. SEARCH 8Es: A novel point of care ultrasound protocol for patients with chest pain, dyspnea or symptomatic hypotension in the emergency department. PLoS One 2017; 12: e0174581
• 86 Daley J, Grotberg J, Pare J. et al. Emergency physician performed tricuspid annular plane systolic excursion in the evaluation of suspected pulmonary embolism. Am J Emerg Med 2017; 35: 106-111
• 87 Daley JI, Dwyer KH, Grunwald Z. et al. Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Acad Emerg Med 2019; 26: 1211-1220
• 88 Nazerian P, Vanni S, Volpicelli G. et al. Accuracy of point-of-care multiorgan ultrasonography for the diagnosis of pulmonary embolism. Chest 2014; 145: 950-957
• 89 Nazerian P, Volpicelli G, Gigli C. et al. Diagnostic accuracy of focused cardiac and venous ultrasound examinations in patients with shock and suspected pulmonary embolism. Intern Emerg Med 2018; 13: 567-574
• 90 Blaivas M, Lambert MJ, Harwood RA. et al. Lower-extremity Doppler for Deep Venous Thrombosis – Can Emergency Physicians Be Accurate and Fast?. Academic Emergency Medicine 2000; 7: 120-126 DOI: 10.1111/j.1553-2712.2000.tb00512.x.
• 91 Frazee BW, Snoey ER, Levitt A. Emergency Department compression ultrasound to diagnose proximal deep vein thrombosis. J Emerg Med 2001; 20: 107-112
• 92 Jang T, Docherty M, Aubin C. et al. Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate. Academic Emergency Medicine 2004; 11: 319-322 DOI: 10.1111/j.1553-2712.2004.tb02220.x.
• 93 Jacoby J, Cesta M, Axelband J. et al. Can emergency medicine residents detect acute deep venous thrombosis with a limited, two-site ultrasound examination?. J Emerg Med 2007; 32: 197-200
• 94 Magazzini S, Vanni S, Toccafondi S. et al. Duplex ultrasound in the emergency department for the diagnostic management of clinically suspected deep vein thrombosis. Acad Emerg Med 2007; 14: 216-220
• 95 Kline JA, O’Malley PM, Tayal VS. et al. Emergency Clinician – Performed Compression Ultrasonography for Deep Venous Thrombosis of the Lower Extremity. Ann Emerg Med 2008; 52: 437-445
• 96 Crisp JG, Lovato LM, Jang TB. Compression ultrasonography of the lower extremity with portable vascular ultrasonography can accurately detect deep venous thrombosis in the emergency department. Ann Emerg Med 2010; 56: 601-610
• 97 Shiver SA, Lyon M, Blaivas M. et al. Prospective comparison of emergency physician–performed venous ultrasound and CT venography for deep venous thrombosis. Am J Emerg Med 2010; 28: 354-358
• 98 Farahmand S, Farnia M, Shahriaran S. et al. The accuracy of limited B-mode compression technique in diagnosing deep venous thrombosis in lower extremities. Am J Emerg Med 2011; 29: 687-690
• 99 Abbasi S, Bolverdi E, Zare MA. et al. Comparison of diagnostic value of conventional ultrasonography by emergency physicians with Doppler ultrasonography by radiology physicians for diagnosis of deep vein thrombosis. J Pak Med Assoc 2012; 62: 461-465
• 100 Torres-Macho J, Antón-Santos JM, García-Gutierrez I. et al. Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period. Am J Emerg Med 2012; 30: 1943-1949
• 101 Crowhurst TD, Dunn RJ. Sensitivity and specificity of three-point compression ultrasonography performed by emergency physicians for proximal lower extremity deep venous thrombosis. Emergency Medicine Australasia 2013; 25: 588-596 DOI: 10.1111/1742-6723.12155.
• 102 Poley RA, Newbigging JL, Sivilotti MLA. Estimated Effect of an Integrated Approach to Suspected Deep Venous Thrombosis Using Limited-compression Ultrasound. Academic Emergency Medicine 2014; 21: 971-980 DOI: 10.1111/acem.12459.
• 103 Kim DJ, Byyny RL, Rice CA. et al. Test Characteristics of Emergency Physician – Performed Limited Compression Ultrasound for Lower-Extremity Deep Vein Thrombosis. The Journal of Emergency Medicine 2016; 51: 684-690 DOI: 10.1016/j.jemermed.2016.07.013.
• 104 Mulcare MR, Lee RW, Pologe JI. et al. Interrater reliability of emergency physician-performed ultrasonography for diagnosing femoral, popliteal, and great saphenous vein thromboses compared to the criterion standard study by radiology. J Clin Ultrasound 2016; 44: 360-367
• 105 Zitek T, Baydoun J, Yepez S. et al. Mistakes and Pitfalls Associated with Two-Point Compression Ultrasound for Deep Vein Thrombosis. West J Emerg Med 2016; 17: 201-208
• 106 García JP, Alonso JV, García PC. et al. Comparison of the Accuracy of Emergency Department-Performed Point-of-Care-Ultrasound (POCUS) in the Diagnosis of Lower-Extremity Deep Vein Thrombosis. The Journal of Emergency Medicine 2018; 54: 656-664 DOI: 10.1016/j.jemermed.2017.12.020.
• 107 Pujol S, Laurent J, Markarian T. et al. Compression with a pocket-sized ultrasound device to diagnose proximal deep vein thrombosis. Am J Emerg Med 2018; 36: 1262-1264
• 108 Seyedhosseini J, Fadavi A, Vahidi E. et al. Impact of point-of-care ultrasound on disposition time of patients presenting with lower extremity deep vein thrombosis, done by emergency physicians. Turk J Emerg Med 2018; 18: 20-24
• 109 Zuker-Herman R, Ayalon Dangur I, Berant R. et al. Comparison between two-point and three-point compression ultrasound for the diagnosis of deep vein thrombosis. J Thromb Thrombolysis 2018; 45: 99-105
• 110 Jahanian F, Khatir I, Mostafavi E. et al. Diagnostic Accuracy of a Three-point Compression Ultrasonography Performed by Emergency Medicine Resident for the Diagnosis of Deep Vein Thrombosis: a Prospective Diagnostic Study. Acta Informatica Medica 2019; 27: 119 DOI: 10.5455/aim.2019.27.119-122.
• 111 Dehbozorgi A, Damghani F, Mousavi-Roknabadi RS. et al. Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department. J Res Med Sci 2019; 24: 80
• 112 Goodman TR, Traill ZC, Phillips AJ. et al. Ultrasound detection of pneumothorax. Clin Radiol 1999; 54: 736-739
• 113 Lichtenstein D, Mezière G, Biderman P. et al. The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Medicine 1999; 25: 383-388 DOI: 10.1007/s001340050862.
• 114 Rowan KR, Kirkpatrick AW, Liu D. et al. Traumatic Pneumothorax Detection with Thoracic US: Correlation with Chest Radiography and CT—Initial Experience. Radiology 2002; 225: 210-214
• 115 Kirkpatrick AW, Sirois M, Laupland KB. et al. Hand-Held Thoracic Sonography for Detecting Post-Traumatic Pneumothoraces: The Extended Focused Assessment With Sonography For Trauma (EFAST). The Journal of Trauma: Injury, Infection, and Critical Care 2004; 57: 288-295 DOI: 10.1097/01.ta.0000133565.88871.e4.
• 116 Chung MJ, Goo JM, Im JG. et al. Value of high-resolution ultrasound in detecting a pneumothorax. Eur Radiol 2005; 15: 930-935
• 117 Reissig A, Kroegel C. Accuracy of transthoracic sonography in excluding post-interventional pneumothorax and hydropneumothorax. Comparison to chest radiography. Eur J Radiol 2005; 53: 463-470
• 118 Lichtenstein DA, Mezière G, Lascols N. et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33: 1231-1238
• 119 Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med 2005; 12: 844-849
• 120 Zhang M, Liu ZH, Yang JX. et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care 2006; 10: R112
• 121 Garofalo G, Busso M, Perotto F. et al. Ultrasound diagnosis of pneumothorax. Radiol Med 2006; 111: 516-525
• 122 Sartori S, Tombesi P, Trevisani L. et al. Accuracy of transthoracic sonography in detection of pneumothorax after sonographically guided lung biopsy: prospective comparison with chest radiography. Am J Roentgenol 2007; 188: 37-41
• 123 Soldati G, Testa A, Sher S. et al. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest 2008; 133: 204-211
• 124 Brook OR, Beck-Razi N, Abadi S. et al. Sonographic Detection of Pneumothorax by Radiology Residents as Part of Extended Focused Assessment With Sonography for Trauma. Journal of Ultrasound in Medicine 2009; 28: 749-755 DOI: 10.7863/jum.2009.28.6.749.
• 125 Vezzani A, Brusasco C, Palermo S. et al. Ultrasound localization of central vein catheter and detection of postprocedural pneumothorax: an alternative to chest radiography. Crit Care Med 2010; 38: 533-538
• 126 Nagarsheth K, Kurek S. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan. Am Surg 2011; 77: 480-484
• 127 Xirouchaki N, Magkanas E, Vaporidi K. et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 2011; 37: 1488-1493
• 128 Nandipati KC, Allamaneni S, Kakarla R. et al. Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: experience at a community based level I trauma center. Injury 2011; 42: 511-514
• 129 Hyacinthe AC, Broux C, Francony G. et al. Diagnostic accuracy of ultrasonography in the acute assessment of common thoracic lesions after trauma. Chest 2012; 141: 1177-1183
• 130 Abbasi S, Farsi D, Hafezimoghadam P. et al. Accuracy of emergency physician-performed ultrasound in detecting traumatic pneumothorax after a 2-h training course. Eur J Emerg Med 2013; 20: 173-177
• 131 Donmez H, Tokmak TT, Yildirim A. et al. Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma?. J Clin Ultrasound 2012; 40: 142-146
• 132 Jalli R, Sefidbakht S, Jafari SH. Value of ultrasound in diagnosis of pneumothorax: a prospective study. Emerg Radiol 2013; 20: 131-134
• 133 Ku BS, Fields JM, Carr B. et al. Clinician-performed Beside Ultrasound for the Diagnosis of Traumatic Pneumothorax. West J Emerg Med 2013; 14: 103-108
• 134 Shostak E, Brylka D, Krepp J. et al. Bedside sonography for detection of postprocedure pneumothorax. J Ultrasound Med 2013; 32: 1003-1009
• 135 Ianniello S, Di Giacomo V, Sessa B. et al. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med 2014; 119: 674-680
• 136 Daabis R, Banawan L, Rabea A. et al. Relevance of chest sonography in the diagnosis of acute respiratory failure: Comparison with current diagnostic tools in intensive care units. Egyptian Journal of Chest Diseases and Tuberculosis 2014; 63: 979-985
• 137 Haghighi SHO, Adimi I, Vahdati SS. et al. Ultrasonographic Diagnosis of Suspected Hemopneumothorax in Trauma Patients. Trauma Monthly 2014; 19 DOI: 10.5812/traumamon.17498.
• 138 Vafaei A, Hatamabadi HR, Heidary K. et al. Diagnostic Accuracy of Ultrasonography and Radiography in Initial Evaluation of Chest Trauma Patients. Emerg (Tehran) 2016; 4: 29-33
• 139 Balesa J, Rathi V, Kumar S. et al. Chest Sonography in the Diagnosis of Pneumothorax. Indian J Chest Dis Allied Sci 2015; 57: 7-11
• 140 Ziapour B, Haji HS. “Anterior convergent” chest probing in rapid ultrasound transducer positioning versus formal chest ultrasonography to detect pneumothorax during the primary survey of hospital trauma patients: a diagnostic accuracy study. Journal of Trauma Management & Outcomes 2015; 9 DOI: 10.1186/s13032-015-0030-5.
• 141 Soult MC, Weireter LJ, Britt RC. et al. Can Routine Trauma Bay Chest X-ray be Bypassed with an Extended Focused Assessment with Sonography for Trauma Examination?. The American Surgeon 2015; 81: 336-340 DOI: 10.1177/000313481508100420.
• 142 Kaya S. A Study on the Evaluation of Pneumothorax by Imaging Methods in Patients Presenting to Emergency Department for Blunt Thoracic Trauma. Turkish Journal of Trauma and Emergency Surgery 2015; DOI: 10.5505/tjtes.2015.91650.
• 143 Helland G, Gaspari R, Licciardo S. et al. Comparison of Four Views to Single‐view Ultrasound Protocols to Identify Clinically Significant Pneumothorax. Academic Emergency Medicine 2016; 23: 1170-1175 DOI: 10.1111/acem.13054.
• 144 Tasci O, Hatipoglu ON, Cagli B. et al. Sonography of the chest using linear-array versus sector transducers: Correlation with auscultation, chest radiography, and computed tomography. Journal of Clinical Ultrasound 2016; 44: 383-389 DOI: 10.1002/jcu.22331.
• 145 Abdalla W, Elgendy M, Abdelaziz AA. et al. Lung ultrasound versus chest radiography for the diagnosis of pneumothorax in critically ill patients: A prospective, single-blind study. Saudi J Anaesth 2016; 10: 265-269
• 146 Amir R, Knio ZO, Mahmood F. et al. Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax*. Critical Care Medicine 2017; 45: 1192-1198 DOI: 10.1097/ccm.0000000000002451.
• 147 Elmahalawy II, Doha NM, Ebeid OM. et al. Role of thoracic ultrasound in diagnosis of pulmonary and pleural diseases in critically ill patients. Egyptian Journal of Chest Diseases and Tuberculosis 2017; 66: 261-266 DOI: 10.1016/j.ejcdt.2016.10.005.
• 148 Kozaci N, Avcı M, Ararat E. et al. Comparison of ultrasonography and computed tomography in the determination of traumatic thoracic injuries. The American Journal of Emergency Medicine 2019; 37: 864-868 DOI: 10.1016/j.ajem.2018.08.002.
• 149 Zieleskiewicz L, Fresco R, Duclos G. et al. Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: Impact on the management of 756 patients. Injury 2018; 49: 1774-1780 DOI: 10.1016/j.injury.2018.07.002.
• 150 Mohamed E, Mohamed EM. In diagnosis of pleural effusion and pneumothorax in the intensive care unit patients: Can chest us replace bedside plain radiography?. The Egyptian Journal of Radiology and Nuclear Medicine 2018; 49: 346-351 DOI: 10.1016/j.ejrnm.2018.02.006.
• 151 Patella M, Saporito A, Puligheddu C. et al. Lung Ultrasound to Detect Residual Pneumothorax After Chest Drain Removal in Lung Resections. The Annals of Thoracic Surgery 2018; 105: 1537-1542 DOI: 10.1016/j.athoracsur.2017.12.008.
• 152 Winkler MH, Touw HR, van de Ven PM. et al. Diagnostic Accuracy of Chest Radiograph, and When Concomitantly Studied Lung Ultrasound, in Critically Ill Patients With Respiratory Symptoms. Critical Care Medicine 2018; 46: e707-e714 DOI: 10.1097/ccm.0000000000003129.
• 153 Ebrahimi A, Yousefifard M, Mohammad Kazemi H. et al. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos 2014; 13: 29-40
• 154 Alrajab S, Youssef AM, Akkus NI. et al. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care 2013; 17: R208
• 155 Alrajhi K, Woo MY, Vaillancourt C. Test Characteristics of Ultrasonography for the Detection of Pneumothorax. Chest 2012; 141: 703-708 DOI: 10.1378/chest.11-0131.
• 156 Hew M, Tay TR. The efficacy of bedside chest ultrasound: from accuracy to outcomes. European Respiratory Review 2016; 25: 230-246 DOI: 10.1183/16000617.0047-2016.
• 157 Ding W, Shen Y, Yang J. et al. Diagnosis of Pneumothorax by Radiography and Ultrasonography. Chest 2011; 140: 859-866 DOI: 10.1378/chest.10-2946.
• 158 Ma OJ, John Ma O, Mateer JR. Trauma Ultrasound Examination Versus Chest Radiography in the Detection of Hemothorax. Annals of Emergency Medicine 1997; 29: 312-316 DOI: 10.1016/s0196-0644(97)70341-x.
• 159 Kataoka H, Takada S. The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. Journal of the American College of Cardiology 2000; 35: 1638-1646 DOI: 10.1016/s0735-1097(00)00602-1.
• 160 Lichtenstein D, Goldstein I, Mourgeon E. et al. Comparative Diagnostic Performances of Auscultation, Chest Radiography, and Lung Ultrasonography in Acute Respiratory Distress Syndrome. Anesthesiology 2004; 100: 9-15 DOI: 10.1097/00000542-200401000-00006.
• 161 Rocco M, Carbone I, Morelli A. et al. Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma. Acta Anaesthesiologica Scandinavica 2008; 52: 776-784 DOI: 10.1111/j.1399-6576.2008.01647.x.
• 162 Zanobetti M, Poggioni C, Pini R. Can Chest Ultrasonography Replace Standard Chest Radiography for Evaluation of Acute Dyspnea in the ED?. Chest 2011; 139: 1140-1147 DOI: 10.1378/chest.10-0435.
• 163 Schleder S, Dornia C, Poschenrieder F. et al. Bedside diagnosis of pleural effusion with a latest generation hand-carried ultrasound device in intensive care patients. Acta Radiologica 2012; 53: 556-560 DOI: 10.1258/ar.2012.110676.
• 164 Inglis AJ, Nalos M, Sue KH. et al. Bedside lung ultrasound, mobile radiography and physical examination: a comparative analysis of diagnostic tools in the critically ill. Crit Care Resusc 2016; 18: 124
• 165 Yousefifard M, Baikpour M, Ghelichkhani P. et al. Screening performance characteristic of ultrasonography and radiography in detection of pleural effusion; A meta-analysis. Emerg (Tehran) 2016; 4: 1-10
• 166 Grimberg A, Shigueoka DC, Atallah AN. et al. Diagnostic accuracy of sonography for pleural effusion: systematic review. Sao Paulo Med J 2010; 128: 90-95
• 167 Chavez MA, Shams N, Ellington LE. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res 2014; 15: 50
• 168 Hew M, Corcoran JP, Harriss EK. et al. The diagnostic accuracy of chest ultrasound for CT-detected radiographic consolidation in hospitalised adults with acute respiratory failure: a systematic review. BMJ Open 2015; 5: e007838
• 169 Strøm JJ, Haugen PS, Hansen MP. et al. Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review. BMJ Open 2020; 10: e036067 DOI: 10.1136/bmjopen-2019-036067.
• 170 Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Accuracy of Lung Ultrasonography in the Diagnosis of Pneumonia in Adults: Systematic Review and Meta-Analysis. Chest 2017; 151: 374-382
• 171 Orso D, Guglielmo N, Copetti R. Lung ultrasound in diagnosing pneumonia in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med 2018; 25: 312-321
• 172 Staub LJ, Biscaro RRM, Kaszubowski E. et al. Lung Ultrasound for the Emergency Diagnosis of Pneumonia, Acute Heart Failure, and Exacerbations of Chronic Obstructive Pulmonary Disease/Asthma in Adults: A Systematic Review and Meta-analysis. The Journal of Emergency Medicine 2019; 56: 53-69 DOI: 10.1016/j.jemermed.2018.09.009.
• 173 Long L, Zhao HT, Zhang ZY. et al. Lung ultrasound for the diagnosis of pneumonia in adults: A meta-analysis. Medicine 2017; 96: e5713
• 174 Xia Y, Ying Y, Wang S. et al. Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis. J Thorac Dis 2016; 8: 2822-2831
• 175 Ye X, Xiao H, Chen B. et al. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS One 2015; 10: e0130066
• 176 Baker K, Brierley S, Kinnear F. et al. Implementation study reporting diagnostic accuracy, outcomes and costs in a multicentre randomised controlled trial of non‐expert lung ultrasound to detect pulmonary oedema. Emergency Medicine Australasia 2020; 32: 45-53 DOI: 10.1111/1742-6723.13333.
• 177 Pivetta E, Goffi A, Nazerian P. et al. Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial. Eur J Heart Fail 2019; 21: 754-766
• 178 Wooten WM, Shaffer LET, Hamilton LA. Bedside Ultrasound Versus Chest Radiography for Detection of Pulmonary Edema: A Prospective Cohort Study. J Ultrasound Med 2019; 38: 967-973
• 179 Mumoli N, Vitale J, Giorgi-Pierfranceschi M. et al. Accuracy of Nurse-Performed Lung Ultrasound in Patients With Acute Dyspnea: A Prospective Observational Study. Medicine 2016; 95: e2925
• 180 Pivetta E, Goffi A, Lupia E. et al. Lung Ultrasound-Implemented Diagnosis of Acute Decompensated Heart Failure in the ED. Chest 2015; 148: 202-210
• 181 Anderson KL, Jenq KY, Fields JM. et al. Diagnosing heart failure among acutely dyspneic patients with cardiac, inferior vena cava, and lung ultrasonography. Am J Emerg Med 2013; 31: 1208-1214
• 182 Cibinel GA, Casoli G, Elia F. et al. Diagnostic accuracy and reproducibility of pleural and lung ultrasound in discriminating cardiogenic causes of acute dyspnea in the emergency department. Intern Emerg Med 2012; 7: 65-70
• 183 Maw AM, Hassanin A, Ho PM. et al. Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2: e190703
• 184 Al Deeb M, Barbic S, Featherstone R. et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med 2014; 21: 843-852