Point-of-care Ultrasound in Morbidity and Mortality Cases in Emergency Medicine: Who Benefits the Most?

Who Benefits the Most?

Andrew J. Goldsmith, MD, MBA; Hamid Shokoohi, MD MPH; Michael Loesche, MD, PhD; Ravish C. Patel; Heidi Kimberly, MD; Andrew Liteplo, MD

Disclosures

Western J Emerg Med. 2020;21(6):172-178. 

In This Article

Limitations

There are several limitations in our study. One limitation was response bias as the results represent the views of the individual respondents. All cases were initially reviewed for patient-related concerns by both the PGY-4 and an EM attending who were not a part of the study, so selection of cases was not biased. However, our surveys were completed by PGY-4 residents only and represent their views of the case. By using PGY-4s it is reasonable to say that they are not expert users of POCUS or experts in medical management, leading to possible inaccurate results. However, an US-trained attending reviewed all the cases and had high agreement with the PGY-4 opinions of the case. Second, all cases that had possible clinical errors were reviewed by an EM attending for agreement.

Another limitation was that the individuals administrating the survey were US faculty. This could have potentially led to some indirect bias on the part of the PGY-4s' responses. Our study was also limited in that we had a relatively low sample size and it was done in academic EDs, potentially leading to limitations regarding the generalizability of our study. However, past studies surrounding M&M process have had similar numbers when reporting.[17,18] Finally, perfect conditions were assumed in cases where POCUS was felt to potentially have a role in preventing an M&M. In reality, it is not the case that images are always correctly obtained, interpreted, and integrated; so the perceived potential benefit of POCUS is a theoretical one. There are many factors related to the patient, provider, and clinical environment that also affect the utility of POCUS and likelihood that it is performed that we could not control for in our model.

processing....