John L Kendall

All Publications

• A Man With Neck Pain and Swelling. Journal of the American College of Emergency Physicians open Perez-Cruet, J. M., Ghaith, S., Cortez, B., Kendall, J. L., Batchelor, T. J. 2026; 7 (3): 100408

  View details for DOI 10.1016/j.acepjo.2026.100408

  View details for PubMedID 42094253

  View details for PubMedCentralID PMC13140020

• Validity Evidence for the New American Board of Emergency Medicine Certifying Examination AEM EDUCATION AND TRAINING Gottlieb, M., Holzman, M., Joldersma, K. B., Ruff, K. C., Farrell, S. E., Ankel, F. K., Kendall, J. L., Barton, M. A., Gorgas, D. L. 2026; 10 (2)

  View details for DOI 10.1002/aet2.70159

  View details for Web of Science ID 001728609100001

• Impact of tele-ultrasound on novice users in patients with suspected COVID-19 in an urgent care setting FRONTIERS IN DIGITAL HEALTH Kendall, J. L., Janik, S., Khalil, P., Scheel, T., Breyer, M., Trent, S. A., Riscinti, M. 2026; 7: 1703121

  Abstract

  Point-of-care lung ultrasound (LUS) has been described for the evaluation of lung pathologies such as pneumothorax, pneumonia, and COVID-19 infections. It is rapidly deployed, portable, and accurate for LUS diagnoses. However, a learning curve limits its use, and teleguidance has been proposed as a solution. In this study, we primarily seek to measure the effect of tele-guided lung ultrasound (T-LUS) on chest X-ray (CXR) utilization in patients presenting with COVID-19 symptoms. Secondarily, we measure the effect of T-LUS on clinical decision-making, length of stay, and clinical outcomes.We performed a retrospective observational study using a before-after design in an adult urgent care (AUC) setting. A total of 303 patients with symptoms suggestive of COVID-19 were included. AUC providers used T-LUS on 31% of patients with COVID-19 symptoms (n = 34). Abnormal LUS findings were found in 41% of patients (n = 14), with B-lines (86%) and pleural irregularities (79%) being the most common findings. Among all patients in the study period, those who received a T-LUS did not show a statistically significant difference in CXR utilization [-12% difference; 95% confidence interval (CI) -25% to 5%] as compared to patients who did not receive a T-LUS, and a similarly non-significant difference was observed in the intervention period (-5% difference; 95% CI: -21% to 14%). Length of stay was longer for patients in whom T-LUS was used (median difference 26 min, 95% CI 11-41). However, a comparison of patients in the intervention period revealed no significant difference in length of stay between patients who received T-LUS and those that did not (median difference 16 min, 95% CI -5 to 37).T-LUS is feasible and alters clinical decision-making for novice ultrasound users in the care of patients with suspected COVID-19 infection. Our results indicated that there was a no statistically significant difference trend in CXR utilization and no improvement in length of stay by the end of the 2-week trial.

  View details for DOI 10.3389/fdgth.2025.1703121

  View details for Web of Science ID 001679083000001

  View details for PubMedID 41646146

  View details for PubMedCentralID PMC12868239

• Declining Performance on American Board of Emergency Medicine Written Examinations. AEM education and training Reisdorff, E. J., Keim, S. M., Gorgas, D. L., White, S. R., Kendall, J. L., Ruff, K. C., Ankel, F. K., Farrell, S. E., Calderon, Y., Gottlieb, M., Bhakta, Y., Barton, M. A., Joldersma, K. B. 2025; 9 (5): e70105

  Abstract

  Emergency medicine (EM) is at a critical juncture with pervasive boarding and overcrowding, a rapid rise in new residency programs, and continuing recovery from the COVID-19 pandemic. These factors could all potentially impact trainees' learning experiences. To explore how this has influenced trainee knowledge acquisition, we analyzed the trends in the American Board of Emergency Medicine (ABEM) In-training Examination (ITE) and the written Qualifying Examination (QE).This was a retrospective study of multiyear performance trends for the ITE (2018-2024) and QE (2019-2024). Only ITE results from residents in categorical ACGME-accredited EM programs were included. ITE performance was the aggregate mean scaled (equated) scores of all EM training levels. The measures for QE performance were the mean scaled scores (equated) and the pass rates. For each test, descriptive statistics were reported and an omnibus analysis of variance (ANOVA) comparing scores across years was computed. When an ANOVA result was statistically significant (α < 0.01), Tukey's tests were performed.For the ITE, there were 61,512 test results, of which 59,075 (96.0%) met inclusion criteria. The mean (SD) scaled ITE scores declined from 77.36 (8.85) in 2018 to 72.19 (9.44) in 2024. The ANOVA for the ITE scaled scores was statistically significant (p < 0.01). The QE had 17,040 test results, of which 15,651 (91.8%) met inclusion criteria. The mean (SD) scaled scores declined from 82.8 (4.6) in 2019 to 80.5 (4.5) in 2024, while the pass rate also declined from 92.3% in 2019 to 82.0% in 2024. The ANOVA for the QE scaled scores across years was significant (p < 0.01).Physician performance on the ABEM ITE has steadily declined since 2018; performance on the QE has declined since 2019. Future research is needed to understand and address the potential causes of these trends.

  View details for DOI 10.1002/aet2.70105

  View details for PubMedID 41141361

  View details for PubMedCentralID PMC12552112

• Design and implementation of an automated patient-care dashboard to provide individualized patient care data and quality metrics to emergency medicine residents AEM EDUCATION AND TRAINING Miller, D. T., Michael, S. S., Michael, S. H., Bookman, K., Brevik, C., Dewispelaere, W., Johns, C., Kaplan, B., Nguyen, D., Owens, D., Sungar, G., Kendall, J. 2025; 9 (2): e70031

  Abstract

  The emergency department (ED) is a high-stakes training environment for emergency medicine (EM) residents and residents' ability to reflect and self-evaluate patient care is of critical importance. Patient care dashboards have been shown to increase adherence to quality guidelines and improve patient outcomes. The objectives of this study were: (1) to create a comprehensive list of evidence-based, psychologically safe patient care and quality metrics to include in a patient care dashboard for EM residents; (2) to design an EM patient care residency dashboard in a secure, cloud-based environment integrated with the electronic health record (EHR); and (3) to pilot the usability and acceptability of the dashboard among EM residents.We created a list of potential EM resident patient care metrics using ACGME Emergency Medicine Defined Key Index Procedure Minimums, leading EM quality indicators, and current EM dashboard literature. We surveyed PGY-1 to -4 EM residents at a single residency program for their recommendations about inclusion, exclusion, and the psychological safety of each metric. We then developed a dashboard utilizing Power BI software integrated with Epic EHR. After development, we conducted a 2-month pilot evaluation for usability and acceptability among EM residents utilizing a mixed-methods approach.We identified 41 metrics within five domains (productivity metrics, patient safety and leading quality indicators, key procedures, complex/high-acuity cases, and uncertain diagnosis) to consider for inclusion in the dashboard. Residents (n = 32/68; 47% survey completion rate) recommended inclusion of 33 metrics; among these, three were identified as moderate-high psychological risk (ED length of stay, patients per hour, death within 24 h) whereas the rest were considered low psychological risk. Based on these survey results, we created an EM resident patient dashboard using Microsoft Power BI. Over a 2-month pilot period with 16 residents, user data showed a change between each resident's prior patient care review practices and review practices when using a dashboard; specifically, there were notable variations in frequency of use, time spent per review session, number of patients reviewed per session, and data categories reviewed. Eleven of 16 residents completed the technology usability and acceptability survey, with general acceptability and few concerns on usability.Our dashboard provides individualized patient care data to EM residents related to productivity, patient safety and quality, key procedures, complex/high-acuity cases, and uncertain diagnoses. A pilot group of EM residents found the dashboard acceptable and useable. Continued research is needed to explore ideal implementation and integration of patient care dashboards in residency training.

  View details for DOI 10.1002/aet2.70031

  View details for Web of Science ID 001448186600001

  View details for PubMedID 40123719

  View details for PubMedCentralID PMC11924277

• Artificial Intelligence Assistance in Point-of-Care Ultrasound Skill Retention for Novice Users in Space Medicine Scenarios WILDERNESS & ENVIRONMENTAL MEDICINE Hurd, V. S., Valle, M., Kravets, V. G., Anderson, A. L., Le, N., Kendall, J. L., Hayman, A. P., Riscinti, M. 2025; 36 (1_SUPPL): 24S-33S

  Abstract

  IntroductionAs humanity progresses further into space, astronauts must be increasingly independent from mission control, especially in high-consequence medical scenarios. The high-utility and low-mass nature of point-of-care ultrasound (POCUS) makes this imaging modality ideal for spaceflight mission deployment. However, POCUS operator skill degrades over time, presenting an operational barrier to continuous, effective use. Further, formal medical education and POCUS-specific training are not requirements for astronaut candidates, potentially exacerbating skill degradation. Artificial intelligence (AI) assistance may mitigate skill decay, enabling long-term POCUS skill retention. To characterize the utility of this paradigm in space, we evaluated AI assistance effects on POCUS skill retention in subject pools with astronaut-mimicking educational demographics.MethodsThis prospective cohort study included 30 participants, evenly split into unassisted and AI-assisted cohorts. After undergoing 1 training session, participants collected 5 renal images, bladder images, and bladder volume estimations and completed usability and self-confidence surveys immediately, 2 wk, and 8 wk after initial training. Primary outcomes included target organ capture rates, image quality, bladder volume variability, perceived self-confidence, and perceived system usability.ResultsAI assistance minimized bladder volume variability aggregated over time (P=0.004) and 2 wk after training (P=0.009) and mitigated perceived system usability degradation with time (P=0.04). No trends were found in organ-capture abilities, image quality, or self-confidence.ConclusionPOCUS AI decreased bladder volume variability and mitigated system usability decrement. We recommend increasing study duration or reducing the number of data collections in future study designs and the fieldwide adoption of objective ultrasound image-quality metrics.

  View details for DOI 10.1177/10806032241304441

  View details for Web of Science ID 001405444400001

  View details for PubMedID 39748543

• Pragmatic evaluation of point of care lung ultrasound for the triage of COVID-19 patients using a simple scoring matrix: Intraclass-classification and predictive value AMERICAN JOURNAL OF EMERGENCY MEDICINE Tran, T. T., Kaizer, A., Kendall, J. L., Fernandez-Bustamante, A., Riscinti, M., Ng, M., Wilson, J., Fuchita, M. 2025; 88: 180-188

  Abstract

  The value of routine bedside lung ultrasound (LUS) for predicting patient disposition during visits to the Emergency Department (ED) is difficult to quantify. We hypothesized that a simplified scoring of bedside-acquired LUS images for the triage of acute respiratory symptoms in the ED would be associated with patient disposition.For this observational pragmatic study, we reviewed prospectively-collected bedside LUS images from patients presenting to the ED with acute respiratory symptoms. We agreed on a simplified LUS scoring approach (0-3). At least three reviewers blindly assessed the available LUS images for each patient and determined the worst score for each patient and the presence of individual LUS findings. The worst LUS score was used to classify patients' LUS-suggested hospital admission risk. We evaluated the agreement between reviewers and the predictive value of LUS findings for patient disposition.204 patients were eligible, and 126 sets of images were available and scored. The most common LUS finding were isolated B-lines (63.5 % of LUS images), pleural thickening/irregularity (48.4 %), and diffuse B-lines (43.7 %). The patients' worst LUS score were 2 (43.5 %), 3 (26.1 %), 1 (20.7 %), and 0 (9.8 %). There was good agreement among reviewers on the worst LUS score (intra-class correlation coefficient 0.830, 95 % confidence interval (0.772-0.875)) and the LUS-suggested disposition (ICC 0.882, 95 % CI (0.846, 0.911)).A simplified scoring of bedside-acquired LUS images from patients with acute respiratory symptoms at the emergency department reliably predicts patient disposition.

  View details for DOI 10.1016/j.ajem.2024.11.076

  View details for Web of Science ID 001377580400001

  View details for PubMedID 39647225

• Physical and biophysical markers of assessment in medical training: A scoping review of the literature. Medical teacher Miller, D. T., Michael, S., Bell, C., Brevik, C. H., Kaplan, B., Svoboda, E., Kendall, J. 2024: 1-9

  Abstract

  PURPOSE: Assessment in medical education has changed over time to measure the evolving skills required of current medical practice. Physical and biophysical markers of assessment attempt to use technology to gain insight into medical trainees' knowledge, skills, and attitudes. The authors conducted a scoping review to map the literature on the use of physical and biophysical markers of assessment in medical training.MATERIALS AND METHODS: The authors searched seven databases on 1 August 2022, for publications that utilized physical or biophysical markers in the assessment of medical trainees (medical students, residents, fellows, and synonymous terms used in other countries). Physical or biophysical markers included: heart rate and heart rate variability, visual tracking and attention, pupillometry, hand motion analysis, skin conductivity, salivary cortisol, functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The authors mapped the relevant literature using Bloom's taxonomy of knowledge, skills, and attitudes and extracted additional data including study design, study environment, and novice vs. expert differentiation from February to June 2023.RESULTS: Of 6,069 unique articles, 443 met inclusion criteria. The majority of studies assessed trainees using heart rate variability (n=160, 36%) followed by visual attention (n=143, 32%), hand motion analysis (n=67, 15%), salivary cortisol (n=67, 15%), fMRI (n=29, 7%), skin conductivity (n=26, 6%), fNIRs (n=19, 4%), and pupillometry (n=16, 4%). The majority of studies (n=167, 38%) analyzed non-technical skills, followed by studies that analyzed technical skills (n=155, 35%), knowledge (n=114, 26%), and attitudinal skills (n=61, 14%). 169 studies (38%) attempted to use physical or biophysical markers to differentiate between novice and expert.CONCLUSION: This review provides a comprehensive description of the current use of physical and biophysical markers in medical education training, including the current technology and skills assessed. Additionally, while physical and biophysical markers have the potential to augment current assessment in medical education, there remains significant gaps in research surrounding reliability, validity, cost, practicality, and educational impact of implementing these markers of assessment.

  View details for DOI 10.1080/0142159X.2024.2345269

  View details for PubMedID 38688520

• Nontechnically speaking: A review of tools and methods in the teaching and assessment of nontechnical skills in emergency medicine training AEM EDUCATION AND TRAINING Brevik, C., Miller, D., Kendall, J., Michael, S. 2023; 7 (6): e10911

  View details for DOI 10.1002/aet2.10911

  View details for Web of Science ID 001103955900001

  View details for PubMedID 37974662

  View details for PubMedCentralID PMC10641174

• The 2023 Core Content of advanced emergency medicine ultrasonography. Journal of the American College of Emergency Physicians open Adhikari, S., Leo, M., Liu, R., Johnston, M., Keehbauch, J., Barton, M., Kendall, J. 2023; 4 (4): e13015

  Abstract

  In February 2023, the American Board of Emergency Medicine (ABEM) approved modifications to the Advanced Emergency Medicine Ultrasonography (AEMUS) Core Content, which defines the areas of knowledge considered essential for the practice of AEMUS. This manuscript serves as a revision of the AEMUS Core Content originally published in 2014. The revision of the Core Content for AEMUS training aims to establish standardized education and qualifications necessary for AEMUS fellowship program leadership, clinical application, administration, quality improvement, and research. The Core Content provides the organizational framework and serves as the basis for the development of content for the Focused Practice Examination (FPE) administered by ABEM. AEMUS fellowship directors may reference the Core Content when designing AEMUS fellowship curricula to help prepare graduates for the autonomous practice of AEMUS and the FPE. In this article, an updated revision of the previously published AEMUS Core Content is detailed, and the entire development of the Core Content is presented.

  View details for DOI 10.1002/emp2.13015

  View details for PubMedID 37564703

  View details for PubMedCentralID PMC10411060

• Evaluation of a Novel Point-of-Care Ultrasound Curriculum for First-Year Pediatric Residents PEDIATRIC EMERGENCY CARE Hulse, W. N., Bell, C. R., Roosevelt, G. E., Sabbadini, L., Germano, R., Hopkins, E., Kendall, J., Toney, A. G. 2022; 38 (11): 605-608

  Abstract

  The aim of the study is to evaluate a novel point-of-care ultrasound (POCUS) educational curriculum for pediatric residents.The cohort study in graduate medical education was completed from January 2017 to March 2019. Postgraduate year 1 (PGY1) pediatric residents attended the educational curriculum that consisted of 3 half-day sessions over a 3-month period. Each session consisted of a lecture (introduction, extended focused assessment with sonography for trauma, soft tissue/musculoskeletal, cardiac, and resuscitative applications) followed by supervised hands-on scanning sessions. Group ratio was 3 learners to 1 machine/expert instructor. Main outcome measures included pre- and post-written test scores, as well as objective structured clinical examination (OSCE) scores.Forty-nine PGY1 residents (78% women) completed the curriculum. The mean (SD) pretest score was 68% (8.5), and the mean posttest score was 83% (8.3) with a difference of 15 (95% confidence interval, 12.5-17.6; P < 0.001). Mean (SD) focused assessment with sonography for trauma OSCE score after the curriculum was 88.7% (11.9). The number of PGY1 pediatric residents that were comfortable performing POCUS examinations increased from pretraining to posttraining for soft tissue/musculoskeletal (14%-61%, P < 0.001), extended focused assessment with sonography for trauma (24%-90%, P < 0.001), and cardiac (18%-86%, P < 0.001). All participants found the curriculum useful, and 42 of 49 (86%) stated the curriculum increased their ability to acquire and interpret images.Postgraduate year 1 pediatric residents learned the basics of POCUS through 3 brief educational sessions. The increase in posttest scores demonstrated improved POCUS knowledge, and the high OSCE score demonstrated their ability to acquire ultrasound images. Point-of-care ultrasound guidelines are needed for pediatric residency programs.

  View details for DOI 10.1097/PEC.0000000000002853

  View details for Web of Science ID 000878255400006

  View details for PubMedID 36314862

• Use of Hand-motion Analysis to Assess Competence and Skill Decay for Cardiac and Lung Point-of-care Ultrasound. AEM education and training Ackil, D. J., Toney, A., Good, R., Ross, D., Germano, R., Sabbadini, L., Thiessen, M., Bell, C., Kendall, J. L. 2021; 5 (3): e10560

  Abstract

  Assessment of competence in technical skills, including point-of-care ultrasound (POCUS), is required before a novice can safely perform the skill independently. Ongoing assessment of competence is also required because technical skills degrade over time, especially when they are infrequently performed or complex. Hand-motion analysis (HMA) is an objective assessment tool that has been used to evaluate competency in many technical skills. The purpose of this study was to demonstrate the feasibility and validity of HMA as an assessment tool for competence in both simple and complex technical skills as well as skill degradation over time.This prospective cohort study included 36 paramedics with no POCUS experience and six physicians who were fellowship trained in POCUS. The novices completed a 4-hour didactic and hands-on training program for cardiac and lung POCUS. HMA measurements, objective structured clinical examinations (OSCE), and written examinations were collected for novices immediately before and after training as well as 2 and 4 months after training. Expert HMA metrics were also recorded.Expert HMA metrics for cardiac and lung POCUS were significantly better than those of novices. After completion of the training program, the novices improved significantly in all HMA metrics, knowledge test scores, and OSCE scores. Novices showed skill degradation in cardiac POCUS based on HMA metrics and OSCE scores while lung POCUS image acquisition skills were preserved. Novices deemed competent by OSCE score performed significantly better in HMA metrics than those not deemed competent.We have demonstrated that HMA is a feasible and valid tool for assessment of competence in technical skills and can also evaluate skill degradation over time. Skill degradation appears more apparent in complex skills, such as cardiac POCUS. HMA may provide a more efficient and reliable assessment of technical skills, including POCUS, when compared to traditional assessment tools.

  View details for DOI 10.1002/aet2.10560

  View details for PubMedID 34124508

  View details for PubMedCentralID PMC8171793

• Ultrasound Hypotension Protocol Time-motion Study Using the Multifrequency Single Transducer Versus a Multiple Transducer Ultrasound Device WESTERN JOURNAL OF EMERGENCY MEDICINE Sabbadini, L., Germano, R., Hopkins, E., Haukoos, J. S., Kendall, J. L. 2021; 22 (3): 775-781

  Abstract

  Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The time for task switching between presets and transducers to perform an UHP has not been previously studied. A novel hand-carried ultrasound (HCU) has been developed that uses a multifrequency single transducer to image areas of the body (lung, heart, abdomen, superficial) that would typically require three transducers using a traditional cart-based ultrasound (CBU) system. Our primary aim was to compare the time to complete UHPs with a single transducer HCU to a multiple transducer CBU.We performed a randomized, crossover feasibility trial in the emergency department of an urban, safety-net hospital. This was a convenience sample of non-hypotensive emergency department patients presenting during a two-month period of time. Ultrasound hypotension protocols were performed by emergency physicians (EP) on patients using the HCU and the CBU. The EPs collected UHP views in sequential order using the most appropriate transducer and preset for the area/organ to be imaged. Time to complete each view, time for task switching, total time to complete the examination, and image diagnostic quality were recorded.A total of 29 patients were scanned by one of eight EPs. When comparing the HCU to the CBU, the median time to complete the UHP was 4.3 vs 8.5 minutes (P <0.0001), respectively. When the transport and plugin times were excluded, the median times were 4.1 vs 5.8 minutes (P <0.0001), respectively. There was no difference in the diagnostic quality of images obtained by the two devices.Ultrasound hypotension protocols were performed significantly faster using the single transducer HCU compared to a multiple transducer CBU with no difference in the number of images deemed to be diagnostic quality.

  View details for DOI 10.5811/westjem.2020.12.47862

  View details for Web of Science ID 000658363300048

  View details for PubMedID 34125060

  View details for PubMedCentralID PMC8202981

• Differences in Gaze Fixation Location and Duration Between Resident and Fellowship Sonographers Interpreting a Focused Assessment With Sonography in Trauma Bell, C. R., Szulewski, A., Walker, M., McKaigney, C., Ross, G., Rang, L., Newbigging, J., Kendall, J. WILEY. 2021: 28-36

  Abstract

  We quantified the gaze fixation duration of resident and fellowship sonographers interpreting a prerecorded focused assessment with sonography in trauma (FAST). We hypothesized that all sonographers would fixate on each relevant anatomic relationship but that the duration of fixation would differ.We conducted a cross-sectional study collecting and analyzing the gaze fixations of a convenience sample of current resident and fellowship sonographers. All sonographers viewed a standardized FAST video, and their gaze fixations were recorded using a Tobii X3-120 eye-tracking bar. Gaze fixations over nine anatomic regions of interest (ROIs) were identified. These were assessed for normality and analyzed using the Wilcoxon rank sum test at an alpha of 0.05 and Bonferroni correction p value of <0.0034. The chi-square test and Pearson's correlation were performed to assess statistical association.The gaze fixation recordings of 24 resident and eight fellowship sonographers were suitable for analysis. Fourteen of the 24 resident sonographers viewed all ROIs in the FAST, whereas all eight fellowship sonographers viewed each of the nine relevant ROIs. Five ROIs were identified over which at least one resident sonographer did not have a gaze fixation. No statistically significant difference was identified between groups. Resident sonographers gaze fixated over the left upper quadrant (LUQ) splenorenal interface for a median (interquartile range) of 10.64 (9.73-11.60) seconds. The fellowship group viewed the same ROI for 8.43 (6.64-8.95) seconds (p < 0.003). All participants viewed this ROI. No other ROIs had a statistical difference.Five ROIs were identified that were not visually interrogated by all resident sonographers. Only 14 of 24 resident sonographers visually interrogated every area in the FAST, whereas all fellowship sonographers interrogated every ROI. A statistically significant difference was found in gaze fixation duration between resident and fellowship sonographers in one ROI. Further study is required for gaze fixation assessment to become a tool for the interpretation component of point-of-care ultrasound.

  View details for DOI 10.1002/aet2.10439

  View details for Web of Science ID 000769578800005

  View details for PubMedID 33521488

  View details for PubMedCentralID PMC7821074

• Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners: Web-Based E-Learning Versus Traditional Classroom Didactic PEDIATRIC EMERGENCY CARE Soon, A., Toney, A., Stidham, T., Kendall, J., Roosevelt, G. 2020; 36 (7): 317-321

  Abstract

  To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS).We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test. They also received hands-on training and completed an objective structured clinical examination. The participants were invited to return 2 months later to test for retention of knowledge and skills.There were no significant differences in the mean written test scores between the classroom group and Web group for the precourse test (absolute difference, -2.5; 95% confidence interval [CI], -12 to 6.9), postcourse test (absolute difference, 2.0; 95% CI, -1.4, 5.3), and postcourse 2-month retention test (absolute difference, -0.8; 95% CI, -9.6 to 8.1). Similarly, no significant differences were noted in the mean objective structured clinical examination scores for both intervention groups in postcourse (absolute difference, 1.9; 95% CI, -4.7 to 8.5) and 2-month retention (absolute difference, -0.6; 95% CI, -10.7 to 9.5).Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of novice learners in POCUS. The usage of Web-based tutorials allows a more efficient use of time and a wider dissemination of knowledge.

  View details for DOI 10.1097/PEC.0000000000001482

  View details for Web of Science ID 000549969600003

  View details for PubMedID 29698340

• Predictors of False-Negative Focused Assessment With Sonography for Trauma Examination in Pediatric Blunt Abdominal Trauma PEDIATRIC EMERGENCY CARE Quan, G. E., Kendall, J. L., Bogseth, M. C., Ruygrok, M. L., Luoma, K. A., Louderback, R. Z., Pieracci, F., Byyny, R. L. 2020; 36 (5): E274-E279

  Abstract

  This study investigated associations between patient and injury characteristics and false-negative (FN) focused assessment with sonography for trauma (FAST) in pediatric blunt abdominal trauma (BAT). We also evaluated the effects of FN FAST on in-hospital mortality and length of stay (LOS) variables.This retrospective cohort studied children younger than 18 years between January 1, 2002, and December 31, 2013, with BAT, documented FAST, and pathologic fluid on computed tomography, surgery, or autopsy. Multivariable and bivariate analyses were used to assess associations between FN FAST and patient injury characteristics, mortality, and hospital LOS.A total of 141 pediatric BAT patients with pathologic free fluid were included. There were no patient or injury characteristics, which conferred increased odds of an FN FAST. Splenic and bladder injury were negatively associated with FN FAST odds ratio of 0.4 (95% confidence interval [CI], 0.2-0.8) and 0.1 (95% CI, 0-0.8). Abbreviated Injury Scale score of 4 or greater to the abdomen and extremity was negatively associated with FN FAST odds ratio of 0.1 (95% CI, 0-0.3) and 0.3 (95% CI, 0.1-0.9). There was no association between FN FAST and mortality. Patients with an FN FAST had increased hospital LOS after controlling for sex, age, and Injury Severity Score.Clinicians need to be cautious applying a single initial FAST to patients with minor abdominal trauma or with suspected injuries to organs other than the spleen or bladder. Formalized studies to develop risk stratification tools could allow clinicians to integrate FAST into the pediatric patient population in the safest manner possible.

  View details for DOI 10.1097/PEC.0000000000002094

  View details for Web of Science ID 000540251200007

  View details for PubMedID 32304524

• EMERGENCY ULTRASOUND LITERATURE AND ADHERENCE TO STANDARDS FOR REPORTING OF DIAGNOSTIC ACCURACY CRITERIA JOURNAL OF EMERGENCY MEDICINE Thiessen, M., Vogel, J. A., Byyny, R. L., Hopkins, E., Haukoos, J. S., Kendall, J. L., Trent, S. A. 2020; 58 (4): 636-645

  Abstract

  Given the wide usage of emergency point-of-care ultrasound (EUS) among emergency physicians (EPs), rigorous study surrounding its accuracy is essential. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were established to ensure robust reporting methodology for diagnostic studies. Adherence to the STARD criteria among EUS diagnostic studies has yet to be reported.Our objective was to evaluate a body of EUS literature shortly after STARD publication for its baseline adherence to the STARD criteria.EUS studies in 5 emergency medicine journals from 2005-2010 were evaluated for their adherence to the STARD criteria. Manuscripts were selected for inclusion if they reported original research and described the use of 1 of 10 diagnostic ultrasound modalities designated as "core emergency ultrasound applications" in the 2008 American College of Emergency Physicians Ultrasound Guidelines. Literature search identified 307 studies; of these, 45 met inclusion criteria for review.The median STARD score was 15 (interquartile range [IQR] 12-17), representing 60% of the 25 total STARD criteria. The median STARD score among articles that reported diagnostic accuracy was significantly higher than those that did not report accuracy (17 [IQR 15-19] vs. 11 [IQR 9-13], respectively; p < 0.0001). Seventy-one percent of articles met ≥50% of the STARD criteria (56-84%) and 4% met >80% of the STARD criteria.Significant opportunities exist to improve methodological reporting of EUS research. Increased adherence to the STARD criteria among diagnostic EUS studies will improve reporting and improve our ability to compare outcomes.

  View details for DOI 10.1016/j.jemermed.2019.09.029

  View details for Web of Science ID 000565849600022

  View details for PubMedID 31708317

  View details for PubMedCentralID PMC7202948

• Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement JOURNAL OF VASCULAR ACCESS Good, R. J., Rothman, K. K., Ackil, D. J., Kim, J. S., Orsborn, J., Kendall, J. L. 2019; 20 (3): 301-306

  Abstract

  Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement.We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasound-guided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts.A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%.We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.

  View details for DOI 10.1177/1129729818804997

  View details for Web of Science ID 000468933400008

  View details for PubMedID 30318990

• Effect of Emergency Physician-Performed Point-of-Care Ultrasound and Radiology Department-Performed Ultrasound Examinations on the Emergency Department Length of Stay Among Pregnant Women at Less Than 20 Weeks' Gestation JOURNAL OF ULTRASOUND IN MEDICINE Morgan, B. B., Kao, A., Trent, S. A., Hurst, N., Oliveira, L., Austin, A. L., Kendall, J. L. 2018; 37 (11): 2497-2505

  Abstract

  We sought to confirm retrospective studies that measured an approximately 20% reduction in emergency department (ED) length of stay (LOS) in early-gestation pregnant women who receive emergency physician-performed point-of-care ultrasound (US) examinations rather than radiology department-performed US examinations for evaluation of intrauterine pregnancy (IUP).A randomized controlled clinical trial was performed at an urban academic safety net hospital and 2 Naval medical centers in the United States. The allocation was concealed before enrollment. Clinically stable adult pregnant women at less than 20 weeks' gestation who presented to the ED with abdominal pain or vaginal bleeding were randomized to receive a point-of-care or radiology US to assess for IUP. The primary outcome measure was the ED LOS.A total of 224 patients (point-of-care US, n = 118; radiology US, n = 106) were included for the analysis. The ED LOS was 20 minutes shorter in the point-of-care US arm (95% confidence interval [CI], -54 to 7 minutes). Adjusting for variability due to the location, the ED LOS was calculated to be 31 minutes shorter (95% CI, -64 to 1 minute) than for patients in the radiology US arm. Excluding patients in the point-of-care US arm who crossed over to radiology US after an inconclusive point-of-care US examination, the ED LOS was 75 minutes shorter than in the radiology US arm (95% CI, -97 to -53 minutes).Early-gestation pregnant ED patients requiring pelvic US were discharged earlier when point-of-care US was used rather than radiology US; however, this trial did not achieve our target of 30 minutes. Nevertheless, our data support the routine use of ED point-of-care US for IUP, saving the most time if a conclusive IUP is identified.

  View details for DOI 10.1002/jum.14607

  View details for Web of Science ID 000447864700006

  View details for PubMedID 29574878

• Critical care ultrasound: A national survey across specialties JOURNAL OF CLINICAL ULTRASOUND Stowell, J. R., Kessler, R., Lewiss, R. E., Barjaktarevic, I., Bhattarai, B., Ayutyanont, N., Kendall, J. L. 2018; 46 (3): 167-177

  Abstract

  Management of the critically ill patient requires rapid assessment and differentiation. Point-of-care ultrasound (POCUS) improves diagnostic accuracy and guides resuscitation. This study sought to describe the use of critical care related POCUS amongst different specialties.This study was conducted as an online 18-question survey. Survey questions queried respondent demographics, preferences for POCUS use, and barriers to implementation.2735 recipients received and viewed the survey with 416 (15.2%) responses. The majority of respondents were pulmonary and critical care medicine (62.5%) and emergency medicine (19.9%) providers. Respondents obtained training through educational courses (26.5%), fellowship (23.9%), residency (21.6%), or self-guided learning (17.2%). POCUS use was common for diagnostic and procedural guidance. Emergency medicine providers were more likely to utilize POCUS to evaluate undifferentiated hypotension (98.5%, P < .001), volume status and fluid responsiveness (88.2%, P = .005), and cardiopulmonary arrest (94.1%, P < .001) compared to other specialties. Limited training, competency, or credentialing were the most common barriers, in up to 39.4% of respondents.Study respondents utilize POCUS in a variety of clinical applications. However, a disparity in utilization still exists among clinicians who care for critically ill patients. Overcoming barriers, such as a lack of formalized training, competency, or credentialing, may lead to increased utilization.

  View details for DOI 10.1002/jcu.22559

  View details for Web of Science ID 000426731500001

  View details for PubMedID 29131347

• Improved medical student perception of ultrasound using a paired anatomy teaching assistant and clinician teaching model ANATOMICAL SCIENCES EDUCATION Smith, J. P., Kendall, J. L., Royer, D. F. 2018; 11 (2): 175-184

  Abstract

  This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands-on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant (TA)-clinician pairs in 2015. Both cohorts completed course evaluations which included five US-related items on a four-point scale; cohort responses were compared using Mann-Whitney U tests with significance threshold set at 0.05. The 2015 survey also evaluated the TAs (three items, five-point scale). With the adoption of the TA-clinician teaching model, student ratings increased significantly for four out of five US-items: "US advanced my ability to learn anatomy" increased from 2.91 ± 0.77 to 3.35 ± 0.68 (P < 0.0001), "Incorporating US increased my interest in anatomy" from 3.05 ± 0.84 to 3.50 ± 0.71 (P < 0.0001), "US is relevant to my current educational needs" from 3.36 ± 0.63 to 3.54 ± 0.53 (P = 0.015), and "US training should start in Phase I" from 3.36 ± 0.71 to 3.56 ± 0.59 (P = 0.010). Moreover, more than 84% of students reported that TAs enhanced their understanding of anatomy (mean 4.18 ± 0.86), were a valuable part of US training (mean 4.23 ± 0.89), and deemed the TAs proficient in US (mean 4.24 ± 0.86). By using an anatomy TA-clinician teaching team, this study demonstrated significant improvements in student perceptions of the impact of US on anatomy education and the relevancy of US training to the early stages of medical education. Anat Sci Educ 11: 175-184. © 2017 American Association of Anatomists.

  View details for DOI 10.1002/ase.1722

  View details for Web of Science ID 000426489900007

  View details for PubMedID 28817242

• Establishing an Ultrasound Curriculum in Undergraduate Medical Education How Much Time Does It Take? JOURNAL OF ULTRASOUND IN MEDICINE Siegel-Richman, Y., Kendall, J. 2018; 37 (3): 569-576

  Abstract

  Over the years, the use of ultrasound in the medical profession has become a common occurrence. As a result, many medical schools are considering an ultrasound curriculum for first- and second-year medical students. The question posed by many of these programs is how much time and effort are required to establish such a curriculum. We at the University of Colorado School of Medicine sought to quantify the resources and time required.We conducted a cohort study that analyzed the time spent teaching, as well as the types of instructors (eg, faculty, resident, and peer student) that contributed to our ultrasound curriculum. The study population consisted of instructors who participated in the curriculum during the 2014-2015 academic year. We analyzed the amount of time that facilitators spent teaching and tabulated these data using their specialty.Our data revealed that within an academic year, a combined total of 484 hours were spent teaching ultrasound to first- and second-year medical students combined. A total of 6 days were required to teach ultrasound to first-year medical students, and a total of 5 days were required for second-year medical students. It required 1 instructor for every 8 students, and most the faculty who volunteered time were from the field of emergency medicine, followed by family medicine and radiology.We describe the number of hours and instructors required to implement an ultrasound curriculum for undergraduate medical education.

  View details for DOI 10.1002/jum.14371

  View details for Web of Science ID 000425592700004

  View details for PubMedID 28877363

• EMERGENCY PHYSICIANS WHO PRODUCE HIGHER RELATIVE VALUE UNITS PER HOUR SPEND SIMILAR AMOUNTS OF TIME AT PATIENT BEDSIDES AS THEIR COLLEAGUES JOURNAL OF EMERGENCY MEDICINE Breyer, M., Farley, H., Neyman, G., Nichols, W., Kendall, J. 2017; 53 (5): 765-770

  Abstract

  Emergency physicians (EPs) are expected to deliver quality care while maintaining high levels of efficiency and productivity as measured by the relative value unit (RVU).We sought to determine whether academic EPs with higher RVUs spend less time at the bedside than their colleagues.This was a prospective, observational, cohort study. A 13-item task list was generated, pilot-tested, and placed onto a computerized tablet.There was no difference among EPs in terms of time spent at bedside, 26.7% of total time, 17.31 min (95% confidence interval [CI] 14.43-20.19), p = 0.052; resident interaction 13.1%, 8.46 min (95% CI 4.68-12.25), p = 0.959; charting, 11.1%, 7.17 min (95% CI .746-5.65), p = 0.055; information search, 10.5%, 6.80 min (95% CI 0.84-8.52), p = 0.320; walking, 9.0%, 5.86 min (95% CI 5.17-6.54), p = 0.112; consultant interaction, 8.2%, 5.28 min (95% CI 3.18-7.40), p = 0.404; writing orders, 6.5%, 4.19 min (95% CI 3.22-5.15), p = 0.109; nursing interaction, 5.6%, 3.65 min (95% CI 2.54-4.76), p = 0.260; other, 5.2%, 3.65 min (95% CI 1.76-5.02), p = 0.785; medical student interaction, 4.2%, 2.75 min (95% CI 0.53-4.97), p = 0.102; physician assistant interaction, 2.8%, 1.79 min (95% CI 1.08-2.50), p = 0.959; clerical interaction, 1.7%, 1.13 min (95% CI .69-1.57), p = 0.335; and electrocardiogram interpretation, 0.7%, 0.45 min (95% CI .32-.58), p = 0.793.Despite differences in RVU-based productivity data, academic EPs spend similar amounts of time involved in the daily tasks of taking care of patients, underscoring that direct physician-patient interaction is one practice parameter that is not compromised among these EPs.

  View details for DOI 10.1016/j.jemermed.2017.08.010

  View details for Web of Science ID 000416681300042

  View details for PubMedID 29128038

• Incidental Findings in Student Ultrasound Models Implications for Instructors JOURNAL OF ULTRASOUND IN MEDICINE Siegel-Richman, Y., Kendall, J. L. 2017; 36 (8): 1739-1743

  Abstract

  As ultrasonography continues to become integrated into undergraduate medical education, there have been concerns raised about the use of volunteer models and the ability to maintain patient privacy during scanning sessions. To date, there have been no reports on how instructors should manage situations in which incidental findings are made during educational ultrasonography sessions. We present three different examples of incidental findings that occurred at our institution and the various approaches taken by the instructors. Furthermore, we outline an approach that can be utilized by other medical schools to better maintain patient confidentiality.

  View details for DOI 10.7863/ultra.16.08014

  View details for Web of Science ID 000406344700022

  View details for PubMedID 28432807

• Number of Weeks Rotating in the Emergency Department Has a Greater Effect on Ultrasound Milestone Competency Than a Dedicated Ultrasound Rotation JOURNAL OF ULTRASOUND IN MEDICINE Smalley, C. M., Thiessen, M., Byyny, R., Dorey, A., McNair, B., Kendall, J. L. 2017; 36 (2): 335-343

  Abstract

  Ultrasound (US) is vital to modern emergency medicine (EM). Across residencies, there is marked variability in US training. The "goal-directed focused US" part of the Milestones Project states that trainees must correctly acquire and interpret images to achieve a level 3 milestone. Standardized methods by which programs teach these skills have not been established. Our goal was to determine whether residents could achieve level 3 with or without a dedicated US rotation.Thirty-three first- and second-year residents were assigned to control (no rotation) and intervention (US rotation) groups. The intervention group underwent a 2-week curriculum in vascular access, the aorta, echocardiography, focused assessment with sonography for trauma, and pregnancy. To test acquisition, US-trained emergency medicine physicians administered an objective structured clinical examination. To test interpretation, residents had to identify normal versus abnormal findings. Mixed-model logistic regression tested the association of a US rotation while controlling for confounders: weeks in the emergency department (ED) as a resident, medical school US rotation, and postgraduate years.For image acquisition, medical school US rotation and weeks in the ED as a resident were significant (P = .03; P = .04) whereas completion of a US rotation and postgraduate years were not significant. For image interpretation, weeks in the ED as a resident was the only significant predictor of performance (P = .002) whereas completion of a US rotation and medical school US rotation were not significant.To achieve a level 3 milestone, weeks in the ED as a resident were significant for mastering image acquisition and interpretation. A dedicated US rotation did not have a significant effect. A medical school US rotation had a significant effect on image acquisition but not interpretation. Further studies are needed to best assess methods to meet US milestones.

  View details for DOI 10.7863/ultra.15.12044

  View details for Web of Science ID 000392290300012

  View details for PubMedID 27943410

• TEST CHARACTERISTICS OF EMERGENCY PHYSICIAN-PERFORMED LIMITED COMPRESSION ULTRASOUND FOR LOWER-EXTREMITY DEEP VEIN THROMBOSIS JOURNAL OF EMERGENCY MEDICINE Kim, D. J., Byyny, R. L., Rice, C. A., Faragher, J. P., Nordenholz, K. E., Haukoos, J. S., Liao, M. M., Kendall, J. L. 2016; 51 (6): 684-690

  Abstract

  The current literature suggests that emergency physician (EP)-performed limited compression ultrasound (LCUS) is a rapid and accurate test for deep vein thrombosis (DVT).Our primary objective was to determine the sensitivity and specificity of LCUS for the diagnosis of DVT when performed by a large heterogeneous group of EPs.This was a prospective diagnostic test assessment of LCUS conducted at two urban academic emergency departments. The scanning protocol involved compression at the common femoral, superficial femoral, and popliteal veins. Patients were eligible if undergoing radiology department ultrasound of the lower extremity with moderate or high pretest probability for DVT, or low pretest probability for DVT with a positive d-dimer. The enrolling EP performed LCUS before radiology department ultrasound of the same lower extremity. Sensitivity, specificity, and associated 95% confidence intervals (CIs) were calculated with the radiologist interpretation of the radiology department ultrasound as the criterion standard.A total of 56 EPs enrolled 296 patients for LCUS, with a median age of 50 years and 50% female. Fifty (17%) DVTs were identified by radiology department ultrasound, and another five (2%) cases were deemed indeterminate. The sensitivity and specificity of EP-performed LCUS was 86% (95% CI 73-94%) and 93% (95% CI 89-96%), respectively.A large heterogeneous group of EPs with limited training can perform LCUS with intermediate diagnostic accuracy. Unfortunately, LCUS performed by EPs with limited ultrasound training is not sufficiently sensitive or specific to rule out or diagnose DVT as a single testing modality.

  View details for DOI 10.1016/j.jemermed.2016.07.013

  View details for Web of Science ID 000389535500017

  View details for PubMedID 27637139

• Effect of Interventional Program on the Utilization of PACS in Point-of-Care Ultrasound. Journal of digital imaging Kessler, R., Stowell, J. R., Vogel, J. A., Liao, M. M., Kendall, J. L. 2016; 29 (6): 701-705

  Abstract

  While the implementation of Picture Archiving and Communication Systems (PACS) has revolutionized the field of radiology, there has been considerably less utilization of PACS by emergency physicians with point-of-care ultrasound. Benefits of PACS archival of images include improved quality assurance, preservation of image quality, and accessibility of images. Our objective was to determine if a simple interventional program would influence the utilization of PACS in point-of-care ultrasound. A before-after study was conducted in an urban, academic emergency department. Data was collected during a 4-week baseline period, a 12-week intervention period, and a 12-week post-intervention period. The percentage of ultrasound studies archived to PACS was recorded during each week of the study. Interventions were designed to encourage the utilization of PACS. A significant increase in the mean percentage of PACS studies was found between the baseline and intervention period (59.4 %; 95 % CI: 34.76-84.08 %; p < 0.001). Mean percentage of PACS studies at 1-month (74.3 %), 2-month (61.0 %), and 3-month (74.8 %) post-intervention periods remained elevated and were all significantly increased compared to baseline values (p < 0.001). Mean percentages of PACS studies at 1-month, 2-month, and 3-month post-intervention periods were not statistically significant from the intervention period (p = 0.977, p = 0.849, p = 0.967, respectively). A simple interventional program for emergency physicians can significantly increase and sustain the utilization of PACS for point-of-care ultrasound.

  View details for DOI 10.1007/s10278-016-9893-x

  View details for PubMedID 27412670

  View details for PubMedCentralID PMC5114233

• A Survey of Ultrasound Milestone Incorporation Into Emergency Medicine Training Programs JOURNAL OF ULTRASOUND IN MEDICINE Smalley, C. M., Dorey, A., Thiessen, M., Kendall, J. L. 2016; 35 (7): 1517-1521

  Abstract

  With the introduction of the Emergency Medicine Milestone Project in 2013, residencies now assess emergency ultrasound (US) skills at regular intervals. However, it is unclear how programs are implementing the emergency US milestones and assessing competency. With the use of the milestone tool, a survey was distributed to emergency US educators to determine when programs are providing emergency US education, when residents are expected to attain competency, and whether the milestones reflect their expectations of trainees.We conducted a prospective cross-sectional survey study distributed electronically to designated emergency US experts at 169 programs. Participants were queried on education and competency evaluation within the context of the milestones by designating a postgraduate year when the 5 milestone levels were taught and competency was expected. Survey findings were reported as percentages of total respondents from descriptive statistics.Responses were received from 53% of programs, and 99% were familiar with the milestones. Most programs provide level 1 (88%) and 2 (85%) instruction during postgraduate year 1. Most programs expect level 1 competency before residency (61%) and expect mastery of level 2 by the end of postgraduate year 1 (60%). Sixty-two percent believe the milestones do not accurately reflect their expectations, citing insufficient minimum scan numbers, lack of specificity, and unattainable level 5 requirements.There is substantial variability in the frequency and methods of competency evaluation using the emergency US milestones. However, most responders agree that residents should obtain level 2 competency by postgraduate year 1. Variation exists regarding what year and what skills define level 3 or greater competency.

  View details for DOI 10.7863/ultra.15.09012

  View details for Web of Science ID 000382505500018

  View details for PubMedID 27268999

• Ultrasound-Guided Cannulation: Time to Bring Subclavian Central Lines Back WESTERN JOURNAL OF EMERGENCY MEDICINE Rezayat, T., Stowell, J. R., Kendall, J. L., Turner, E., Fox, J., Barjaktarevic, I. 2016; 17 (4): 216-221

  Abstract

  Despite multiple advantages, subclavian vein (SCV) cannulation via the traditional landmark approach has become less used in comparison to ultrasound (US) guided internal jugular catheterization due to a higher rate of mechanical complications. A growing body of evidence indicates that SCV catheterization with real-time US guidance can be accomplished safely and efficiently. While several cannulation approaches with real-time US guidance have been described, available literature suggests that the infraclavicular, longitudinal "in-plane" technique may be preferred. This approach allows for direct visualization of needle advancement, which reduces risk of complications and improves successful placement. Infraclavicular SCV cannulation requires simultaneous use of US during needle advancement, but for an inexperienced operator, it is more easily learned compared to the traditional landmark approach. In this article, we review the evidence supporting the use of US guidance for SCV catheterization and discuss technical aspects of the procedure itself.

  View details for DOI 10.5811/westjem.2016.1.29462

  View details for Web of Science ID 000382837100022

  View details for PubMedID 26973755

  View details for PubMedCentralID PMC4786249

• IMAGES IN EMERGENCY MEDICINE DIAGNOSIS: <i>Atraumatic splenic rupture in the setting of splenic vein thrombosis</i> ANNALS OF EMERGENCY MEDICINE Paull, B., Kessler, R., Kendall, J. L. 2016; 67 (2): 164-+

  View details for DOI 10.1016/j.annemergmed.2015.05.009

  View details for Web of Science ID 000369124400005

  View details for PubMedID 26801376

• Long-Axis Versus Short-Axis View of Ultrasound-Guided Central Venous Cannulation Reply CRITICAL CARE MEDICINE Vogel, J. A., Kendall, J. 2015; 43 (12): E597-E598

  View details for DOI 10.1097/CCM.0000000000001416

  View details for Web of Science ID 000365481800020

  View details for PubMedID 26575684

• Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills WESTERN JOURNAL OF EMERGENCY MEDICINE Schmidt, J. N., Kendall, J., Smalley, C. 2015; 16 (6): 923-926

  Abstract

  Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution.We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images.Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%.Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation.

  View details for DOI 10.5811/westjem.2015.9.28587

  View details for Web of Science ID 000373124900024

  View details for PubMedID 26594291

  View details for PubMedCentralID PMC4651595

• Using Ultrasound to Enhance Medical Students' Femoral Vascular Physical Examination Skills JOURNAL OF ULTRASOUND IN MEDICINE Ahn, J. S., French, A. J., Thiessen, M. E. W., Browne, V., Deutchman, M., Guiton, G., Madigosky, W., Kendall, J. L. 2015; 34 (10): 1771-1776

  Abstract

  To determine whether the addition of ultrasound to traditional physical examination instruction improves junior medical students' abilities to locate the femoral pulse.Initially, 150 second-year medical students were taught the femoral pulse examination using traditional bedside teaching on standardized patients and online didactic videos. Students were then randomized into 2 groups: group 1 received ultrasound training first and then completed the standardized examination; and group 2 performed the standardized examination first and then received ultrasound training. On the standardized patients, the femoral artery was marked with invisible ink before the sessions using ultrasound. Compared to these markers, students were then evaluated on the accuracy of femoral artery pulse palpation and the estimated location of the femoral vein. All students completed a self-assessment survey after the ultrasound sessions.Ultrasound training improved the students' ability to palpate the femoral pulse (P= .02). However, ultrasound did not facilitate correct estimation of the femoral vein's anatomic location (P = .09). Confidence levels in localizing the femoral artery and vein were equal between groups at baseline, and both increased after the ultrasound sessions.The addition of ultrasound teaching to traditional physical examination instruction enhanced medical student competency and confidence with the femoral vascular examination. However, understanding of anatomy may require emphasis on precourse didactic material, but further study is required.

  View details for DOI 10.7863/ultra.15.14.11014

  View details for Web of Science ID 000362622800008

  View details for PubMedID 26324754

• Long-Axis View for Central Venous Access Reply CRITICAL CARE MEDICINE Vogel, J. A., Kendall, J. 2015; 43 (10): E473-E474

  View details for DOI 10.1097/CCM.0000000000001208

  View details for Web of Science ID 000361359700023

  View details for PubMedID 26376278

• Ultrasound-Guided Central Venous Catheterization: It Is High Time to Use a Correct Terminology Reply CRITICAL CARE MEDICINE Vogel, J. A., Kendall, J. 2015; 43 (9): E396

  View details for DOI 10.1097/CCM.0000000000001124

  View details for Web of Science ID 000369256800015

  View details for PubMedID 26274729

• Is long-axis view superior to short-axis view in ultrasound-guided central venous catheterization? Critical care medicine Vogel, J. A., Haukoos, J. S., Erickson, C. L., Liao, M. M., Theoret, J., Sanz, G. E., Kendall, J. 2015; 43 (4): 832-9

  Abstract

  To evaluate whether using long-axis or short-axis view during ultrasound-guided internal jugular and subclavian central venous catheterization results in fewer skin breaks, decreased time to cannulation, and fewer posterior wall penetrations.Prospective, randomized crossover study.Urban emergency department with approximate annual census of 60,000.Emergency medicine resident physicians at the Denver Health Residency in Emergency Medicine, a postgraduate year 1-4 training program.Resident physicians blinded to the study hypothesis used ultrasound guidance to cannulate the internal jugular and subclavian of a human torso mannequin using the long-axis and short-axis views at each site.An ultrasound fellow recorded skin breaks, redirections, and time to cannulation. An experienced ultrasound fellow or attending used a convex 8-4 MHz transducer during cannulation to monitor the needle path and determine posterior wall penetration. Generalized linear mixed models with a random subject effect were used to compare time to cannulation, number of skin breaks and redirections, and posterior wall penetration of the long axis and short axis at each cannulation site. Twenty-eight resident physicians participated: eight postgraduate year 1, eight postgraduate year 2, five postgraduate year 3, and seven postgraduate year 4. The median (interquartile range) number of total internal jugular central venous catheters placed was 27 (interquartile range, 9-42) and subclavian was six catheters (interquartile range, 2-20). The median number of previous ultrasound-guided internal jugular catheters was 25 (interquartile range, 9-40), and ultrasound-guided subclavian catheters were three (interquartile range, 0-5). The long-axis view was associated with a significant decrease in the number of redirections at the internal jugular and subclavian sites, relative risk 0.4 (95% CI, 0.2-0.9) and relative risk 0.5 (95% CI, 0.3-0.7), respectively. There was no significant difference in the number of skin breaks between the long axis and short axis at the subclavian and internal jugular sites. The long-axis view for subclavian was associated with decreased time to cannulation; there was no significant difference in time between the short-axis and long-axis views at the internal jugular site. The prevalence of posterior wall penetration was internal jugular short axis 25%, internal jugular long axis 21%, subclavian short axis 64%, and subclavian long axis 39%. The odds of posterior wall penetration were significantly less in the subclavian long axis (odds ratio, 0.3; 95% CI, 0.1-0.9).The long-axis view for the internal jugular was more efficient than the short-axis view with fewer redirections. The long-axis view for subclavian central venous catheterization was also more efficient with decreased time to cannulation and fewer redirections. The long-axis approach to subclavian central venous catheterization is also associated with fewer posterior wall penetrations. Using the long-axis view for subclavian central venous catheterization and avoiding posterior wall penetrations may result in fewer central venous catheter-related complications.

  View details for DOI 10.1097/CCM.0000000000000823

  View details for PubMedID 25517477

  View details for PubMedCentralID PMC4436655

• ACUTE HEMATOGENOUS OSTEOMYELITIS OF THE RIB IDENTIFIED ON BEDSIDE ULTRASOUND JOURNAL OF EMERGENCY MEDICINE Emiley, P. J., Kendall, J. L., Bellows, J. W. 2015; 48 (1): E15-E17

  Abstract

  Osteomyelitis is a challenging and commonly considered diagnosis in the emergency department. Early recognition and treatment with appropriate antibiotic therapy is crucial to prevent complications.This case reviews relevant literature and typical ultrasound features of osteomyelitis. It highlights a previously undescribed and practical application of emergency department bedside ultrasonography, adding to the diagnostic armamentarium for this disease process.A 48-year-old woman presented with fever and left chest wall pain. She had been seen previously for a right axillary abscess requiring incision and drainage. Examination revealed a focal area of chest tenderness without cutaneous changes. Chest x-ray study and laboratory evaluation were nondiagnostic. Bedside ultrasound diagnosed acute hematogenous osteomyelitis of a rib.Bedside ultrasound holds great promise in investigating osteomyelitis when suspicion is high and traditional initial testing is nondiagnostic. Further study is required to quantify this benefit in the emergency department setting and explore utility of negative results.

  View details for DOI 10.1016/j.jemermed.2014.07.031

  View details for Web of Science ID 000346857000004

  View details for PubMedID 25242098

• Ultrasound-guided small vessel cannulation: long-axis approach is equivalent to short-axis in novice sonographers experienced with landmark-based cannulation. The western journal of emergency medicine Erickson, C. S., Liao, M. M., Haukoos, J. S., Douglass, E., DiGeronimo, M., Christensen, E., Hopkins, E., Bender, B., Kendall, J. L. 2014; 15 (7): 824-30

  Abstract

  Our primary objective was to describe the time to vessel penetration and difficulty of long-axis and short-axis approaches for ultrasound-guided small vessel penetration in novice sonographers experienced with landmark-based small vessel penetration.This was a prospective, observational study of experienced certified emergency nurses attempting ultrasound-guided small vessel cannulation on a vascular access phantom. We conducted a standardized training, practice, and experiment session for each participant. Five long-axis and five short-axis approaches were attempted in alternating sequence. The primary outcome was time to vessel penetration. Secondary outcomes were number of skin penetrations and number of catheter redirections. We compared long-axis and short-axis approaches using multivariable regression adjusting for repeated measures, vessel depth, and vessel caliber.Each of 10 novice sonographers made 10 attempts for a total of 100 attempts. Median time to vessel penetration in the long-axis and short-axis was 11 (95% confidence interval [CI] 7-12) and 10 (95% CI 6-13) seconds, respectively. Skin penetrations and catheter redirections were equivalent and near optimal between approaches. The median caliber of cannulated vessels in the long-axis and short-axis was 4.6 (95% CI 4.1-5.5) and 5.6 (95% CI 5.1-6.2) millimeters, respectively. Both axes had equal success rates of 100% for all 50 attempts. In multivariable regression analysis, long-axis attempts were 32% (95% CI 11%-48%; p=0.009) faster than short-axis attempts.Novice sonographers, highly proficient with peripheral IV cannulation, can perform after instruction ultrasound-guided small vessel penetration successfully with similar time to vessel penetration in either the long-axis or short-axis approach on phantom models.

  View details for DOI 10.5811/westjem.2014.9.22404

  View details for PubMedID 25493126

  View details for PubMedCentralID PMC4251227

• E-point septal separation: a bedside tool for emergency physician assessment of left ventricular ejection fraction AMERICAN JOURNAL OF EMERGENCY MEDICINE McKaigney, C. J., Krantz, M. J., La Rocque, C. L., Hurst, N. D., Buchanan, M. S., Kendall, J. L. 2014; 32 (6): 493-497

  Abstract

  Rapid assessment of left ventricular ejection fraction (LVEF) may be critical among emergency department (ED) patients. This study examined the predictive relationship between ED physician performed bedside mitral-valve E-point septal separation (EPSS) measurements to the quantitative, calculated LVEF. We further evaluated the relationship between ED physician visual estimates of global cardiac function (GCF) and calculated LVEF values.A prospective observational study was conducted on a sequential convenience sample of patients receiving comprehensive transthoracic echocardiography (TTE). Three ED ultrasound fellows performed bedside ultrasound examinations to obtain both EPSS measurements and subjective visual GCF estimates. A linear regression analysis was conducted to examine the relation of EPSS to the calculated LVEF from the comprehensive TTE. Agreement (modified Cohen κ) between ED ultrasound fellow GCF estimates and the calculated LVEF was also assessed.Linear regression analyses revealed a significant correlation (r=0.73, P<.001) between bedside EPSS and the calculated LVEF. The sensitivity and specificity of an EPSS measurement of greater than 7 mm for severe systolic dysfunction (LVEF≤30%) were 100.0% (95% confidence interval, 62.9-100.0) and 51.6% (95% confidence interval, 38.6-64.5), respectively. Subjective estimates of GCF were moderately correlated with calculated LVEF (Cohen κ=0.58).Measurements of EPSS by ED physicians were significantly associated with the calculated measurements of LVEF from comprehensive TTE. Subjective visual estimates of GCF, however, demonstrated only moderate agreement with the calculated LVEF. An EPSS measurement greater than 7 mm was uniformly sensitive at identifying patients with severely reduced LVEF.

  View details for DOI 10.1016/j.ajem.2014.01.045

  View details for Web of Science ID 000336581800001

  View details for PubMedID 24630604

• Experience with emergency ultrasound training by Canadian emergency medicine residents. The western journal of emergency medicine Kim, D. J., Theoret, J., Liao, M. M., Kendall, J. L. 2014; 15 (3): 306-11

  Abstract

  Starting in 2008, emergency ultrasound (EUS) was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College) emergency medicine (EM) training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents.This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5) EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS.Survey response rate was 95% (37/39). EUS was part of the formal residency curriculum for 86% of respondents (32/37). Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37]) was an ultrasound course, 73% (27/37) of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37]) made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS.EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs. [West J Emerg Med. 2014;15(3):306-311.].

  View details for DOI 10.5811/westjem.2013.9.18025

  View details for PubMedID 24868309

  View details for PubMedCentralID PMC4025528

• Use of Ultrasound Guidance for Central Venous Catheter Placement: Survey From the American Board of Emergency Medicine Longitudinal Study of Emergency PhysiciansUso de la Ecografia para Guiar la Insercion de un Cateter Venoso Central: Encuesta a los Urgenciologos del Estudio Longitudinal de Medicina de Urgencias y Emergencias de la American Board ACADEMIC EMERGENCY MEDICINE Buchanan, M. S., Backlund, B., Liao, M. M., Sun, J., Cydulka, R. K., Smith-Coggins, R., Kendall, J. 2014; 21 (4): 416-421

  Abstract

  The objective was to survey practicing emergency physicians (EPs) across the United States regarding the frequency of using ultrasound (US) guidance in central venous catheter (CVC) placement and, secondarily, to determine factors associated with the use or barriers to the use of US guidance.This was a cross-sectional survey mailed to presumed practicing EPs as part of the American Board of Emergency Medicine (ABEM)'s longitudinal study of EPs. The selection process used stratified, random sampling of cohorts thought to represent four different stages within the development of the specialty of emergency medicine (EM). Multivariable logistic regression was used to identify independent factors associated with both high comfort using US guidance and high-percentage usage of US guidance.The survey was mailed to 1,165 subjects, and the response rate was 79%. The median number of years of practice was 20 (interquartile range [IQR]=7 to 28 years). As their primary practice setting, 64% work in private or community hospitals, 60% received training in US-guided vascular access, and 44% never use US guidance in placing CVCs. Barriers differed in those who never use US and those who sometimes or always used US guidance. In those who never use US, top barriers were insufficient training (67%) and lack of equipment (25%). In those who use US, top barriers were the perceptions that US was too time-consuming (27%) and that the preferred site was not amenable to US (24%). Independent factors associated with high comfort and high-percentage use of US guidance were training in US-guided vascular access (adjusted odds ratio=5.1 [high comfort]; 95% confidence interval [CI]=2.6 to 10.1; adjusted odds ratio 11.1=(high percentage); 95% CI=5.0 to 24.8) and being a recent residency graduate.Among EPs, the translation of evidence to clinical practice regarding the benefits of US guidance for CVC placement is poor and still faces many barriers. Training and education are potentially the best ways to overcome such barriers.

  View details for DOI 10.1111/acem.12350

  View details for Web of Science ID 000334288100008

• Blunt Abdominal Trauma Patients Are at Very Low Risk for Intra-Abdominal Injury after Emergency Department Observation WESTERN JOURNAL OF EMERGENCY MEDICINE Kendall, J. L., Kestler, A. M., Whitaker, K. T., Adkisson, M., Haukoos, J. S. 2011; 12 (4): 496-504

  Abstract

  Patients are commonly admitted to the hospital for observation following blunt abdominal trauma (BAT), despite initially negative emergency department (ED) evaluations. With the current use of screening technology, such as computed tomography (CT) of the abdomen and pelvis, ultrasound, and laboratory evaluations, it is unclear which patients require observation. The objective of this study was to determine the prevalence of intra-abdominal injury (IAI) and death in hemodynamically normal and stable BAT patients with initially negative ED evaluations admitted to an ED observation unit and to define a low-risk subgroup of patients and assess whether they may be discharged without abdominal/pelvic CT or observation.This was a retrospective cohort study performed at an urban level 1 trauma center and included all BAT patients admitted to an ED observation unit as part of a BAT key clinical pathway. All were observed for at least 8 hours as part of the key clinical pathway, and only minors and pregnant women were excluded. Outcomes included the presence of IAI or death during a 40-month follow-up period. Prior to data collection, low-risk criteria were defined as no intoxication, no hypotension or tachycardia, no abdominal pain or tenderness, no hematuria, and no distracting injury. To be considered low risk, patients needed to meet all low-risk criteria.Of the 1,169 patients included over the 2-year study period, 29% received a CT of the abdomen and pelvis, 6% were admitted to the hospital from the observation unit for further management, 0.4% (95% confidence interval [CI], 0.1%-1%) were diagnosed with IAI, and 0% (95% CI, 0%-0.3%) died. Patients had a median combined ED and observation length of stay of 9.5 hours. Of the 237 (20%) patients who met low-risk criteria, 7% had a CT of the abdomen and pelvis and 0% (95% CI, 0%-1.5%) were diagnosed with IAI or died.Most BAT patients who have initially negative ED evaluations are at low risk for IAI but still require some combination of observation and CT. A subgroup of BAT patients may be safely discharged without CT or observation after the initial evaluation.

  View details for DOI 10.5811/westjem.2010.11.2016

  View details for Web of Science ID 000422593300029

  View details for PubMedID 22224146

  View details for PubMedCentralID PMC3236146

• The "guitar pick" sign: a novel sign of retrobulbar hemorrhage CANADIAN JOURNAL OF EMERGENCY MEDICINE Theoret, J., Sanz, G. E., Matero, D., Guth, T., Erickson, C., Liao, M. M., Kendall, J. L. 2011; 13 (3): 162-164

  Abstract

  Retrobulbar hemorrhage is a rare complication of blunt ocular trauma. Without prompt intervention, permanent reduction in visual acuity can develop in as little as 90 minutes. We report a novel bedside ultrasound finding of conical deformation of the posterior ocular globe: the "guitar pick" sign. In our elderly patient, the ocular globe shape normalized post-lateral canthotomy and inferior cantholysis. Identifying this sonographic finding may add to the clinical examination when deciding whether to perform decompression.

  View details for DOI 10.2310/8000.2011.110279

  View details for Web of Science ID 000297838900008

  View details for PubMedID 21524372

• Artifact simulating fracture on cervical spine computed tomography. The western journal of emergency medicine Shockley, L. W., Kendall, J. L. 2011; 12 (2): 240-1

  Abstract

  We present the case of a 31-year-old trauma patient with computed tomography concerning significant C3-C4 subluxation. The abnormality is due to an artifact with which emergency physicians should be aware.

  View details for PubMedID 21691535

  View details for PubMedCentralID PMC3099616

• DIAGNOSIS OF LEMIERRE SYNDROME BY BEDSIDE EMERGENCY DEPARTMENT ULTRASOUND JOURNAL OF EMERGENCY MEDICINE Castro-Marin, F., Kendall, J. L. 2010; 39 (4): 436-439

  Abstract

  Oropharyngeal infections such as pharyngitis and odontogenic abscess are routinely encountered in emergency and primary care medical practice. Lemierre syndrome is a rare but serious complication of such infections. This syndrome is characterized by penetration of the primary infection into the lateral pharyngeal space, suppurative thrombophlebitis of the internal jugular vein, and metastatic infections resulting from septic emboli. A combination of clinical suspicion, microbiologic identification of the causative organism, and diagnostic imaging may be required to make the diagnosis. We present a case of Lemierre syndrome that was rapidly diagnosed in the Emergency Department with bedside ultrasound of the internal jugular vein. This case suggests that bedside ultrasound, performed before other radiologic imaging, may lead to earlier diagnosis and treatment of this syndrome, which historically has been associated with significant morbidity and mortality.

  View details for DOI 10.1016/j.jemermed.2007.10.044

  View details for Web of Science ID 000282862200005

  View details for PubMedID 18403168

• Pilot Study to Determine the Feasibility of Training Army National Guard Medics to Perform Focused Cardiac Ultrasonography PREHOSPITAL EMERGENCY CARE Backlund, B. H., Bonnett, C. J., Faragher, J. P., Haukoos, J. S., Kendall, J. L. 2010; 14 (1): 118-123

  Abstract

  To assess the ability of Army National Guard combat medics to perform a limited bedside echocardiography (BE) to determine cardiac activity after a brief training module.Twelve Army National Guard health care specialists trained to the level of emergency medical technician-basic (EMT-B) underwent an educational session consisting of a 5-minute lecture on BE followed by hands-on practical training. After the training session, each medic performed BEs, in either the subxiphoid (SX) or parasternal (PS) location at his or her discretion, on four healthy volunteers. The time required to complete the BE and the anatomic location of the examination (SX vs. PS) was documented. A 3-second video clip representing the best image was recorded for each BE. These clips were subsequently reviewed independently by two of the investigators with experience performing and interpreting BE; each BE was graded on a six-point scale designed for the study, the Cardiac Ultrasound Structural Assessment Scale (CUSAS). A score of 3 or greater was considered to be adequate to assess for the presence of cardiac activity. Where there was disagreement on the CUSAS score, the reviewers viewed the clip together and agreed on a consensus CUSAS score. We calculated the median time to completion and interquartile range (IQR) for each BE, the median CUSAS scores and IQR for examinations performed in the SX and PS locations, and kappa for agreement between the two reviewers on the CUSAS.A total of 48 BEs were recorded and reviewed. Thirty-seven of 48 (77%) were obtained in the SX location, and 11 of 48 (23%) were obtained in the PS location. Forty-four of 48 (92%) were scored as a 3 or higher on the CUSAS. Median time to completion of a BE was 5.5 seconds (IQR: 3.7-10.9 seconds). The median CUSAS score in the SX location was 4 (IQR: 4-5), and the median CUSAS score in the PS location was 4 (IQR: 4-4). Weighted kappa for the CUSAS was 0.6.With minimal training, the vast majority of the medics in our study were able to rapidly perform a focused BE on live models that was adequate to assess for the presence of cardiac activity.

  View details for DOI 10.3109/10903120903349770

  View details for Web of Science ID 000275250300017

  View details for PubMedID 19947876

• Female with right lower quadrant abdominal pain. Annals of emergency medicine Laselle, B., Devey, J. S., Kendall, J. L. 2009; 54 (2): e8-9

  View details for DOI 10.1016/j.annemergmed.2008.12.036

  View details for PubMedID 19616724

• Emergency Department Ultrasound Is not a Sensitive Detector of Solid Organ Injury. The western journal of emergency medicine Kendall, J. L., Faragher, J., Hewitt, G. J., Burcham, G., Haukoos, J. S. 2009; 10 (1): 1-5

  Abstract

  To estimate the sensitivity and specificity of emergency department (ED) ultrasound for the detection of solid organ injury following blunt abdominal trauma.A prospective cohort study performed in the ED of an urban Level I trauma center on patients who sustained blunt abdominal trauma. Following initial standard trauma evaluation, patients underwent a secondary ultrasound examination performed specifically to identify injury to the liver or spleen, followed by computed tomography (CT) scan of the abdomen. Ultrasound examinations were performed by emergency medicine residents or attending physicians experienced in the use of ultrasound for detecting hemoperitoneum. Ultrasonographers prospectively determined the presence or absence of liver or spleen injury. CT findings were used as the criterion standard to evaluate the ultrasound results.From July 1998 through June 1999, 152 patients underwent secondary ultrasound examination and CT. Of the 152 patients, nine (6%) had liver injuries and 10 (7%) had spleen injuries. Ultrasound correctly detected only one of the liver injuries for a sensitivity of 11% (95% CI: 0%-48%) and a specificity of 98% (95% CI: 94%-100%). Ultrasound correctly detected eight spleen injuries for a sensitivity of 80% (95% CI: 44%-98%) and a specificity of 99% (95% CI: 95%-100%).Emergency ultrasound is not sensitive or specific for detecting liver or spleen injuries following blunt abdominal trauma.

  View details for PubMedID 19561757

  View details for PubMedCentralID PMC2672300

• History of emergency and critical care ultrasound: The evolution of a new imaging paradigm CRITICAL CARE MEDICINE Kendall, J. L., Hoffenberg, S. R., Smith, R. 2007; 35 (5): S126-S130

  Abstract

  The tradition of clinical ultrasound in the hands of physicians who provide critical care to the most acutely ill patients stretches back into the 1980s and is rich with experiences from surgical, emergency medicine, and other practices. Now, as critical care ultrasound explodes around the world, it is important to realize the path its development has taken and learn from trials and tribulations of early practitioners in the field. The development and battles for the right to use ultrasound at the patient's bedside for >20 yrs is described in relation to its emergency medicine and surgical origins. Approaches to education, scanning, documentation, and organization at the national and regional levels are described.

  View details for DOI 10.1097/01.CCM.0000260623.38982.83

  View details for Web of Science ID 000245958700002

  View details for PubMedID 17446770

• Ultrasonographic measurement of aortic diameter by emergency physicians approximates results obtained by computed tomography JOURNAL OF EMERGENCY MEDICINE Knaut, A. L., Kendall, J. L., Patten, R., Ray, C. 2005; 28 (2): 119-126

  Abstract

  To assess agreement between emergency physicians' measurements of abdominal aortic diameter using ultrasound in the Emergency Department (ED) and measurements obtained by computed tomography (CT), a double-blinded, prospective study was conducted. The study enrolled a convenience sample of patients over 50 years of age presenting to the ED and scheduled to undergo CT scan of the abdomen and pelvis. Before CT scan, each patient received an ultrasound from a resident or attending emergency physician measuring anterior-posterior aortic diameter transversely at the approximate level of the superior mesenteric artery (SMA), longitudinally midway between the SMA and the iliac bifurcation, and transversely approximately 1 cm above the iliac bifurcation. Two radiologists blinded to the ultrasound measurements then independently measured aortic diameters at the corresponding anatomical points as imaged by CT. The ultrasonographic measurements were then compared with an average of the two CT measurements. Forty physicians enrolled a total of 104 patients into the study. Ultrasonographic measurements of aortic diameter were slightly smaller than those obtained by CT scan, with a difference of means of -0.39 cm (95% CI -0.25 to -0.53) at the level of the SMA, -0.26 cm (95% CI -0.17 to -0.36) on longitudinal view, and -0.11 cm (95 % CI -0.01 to 0.22) at the bifurcation. At the level of the SMA, the difference in measurements by ultrasound and CT would be expected to be less than 1.41 cm, 95% of the time. At the bifurcation, we expect 95% of the differences to be less than 1.05 cm. Agreement was closest on longitudinal view, with 95% of the differences expected to be less than 0.94 cm. Participating physicians estimated the time required to complete their ultrasound studies to be less than 5 min in a majority of cases. In conclusion, ultrasonographic measurement of aortic diameter by emergency physicians rapidly and effectively approximates measurements obtained by CT scan.

  View details for DOI 10.1016/j.jemermed.2004.07.013

  View details for Web of Science ID 000227079000001

  View details for PubMedID 15707804

• Emergency department ultrasound for hemothorax after blunt traumatic injury JOURNAL OF EMERGENCY MEDICINE Abboud, P. A., Kendall, J. 2003; 25 (2): 181-184

  Abstract

  Diagnosing hemothorax after blunt trauma may be aided by emergency department (ED) ultrasound (US). Various prior studies have evaluated ED US using different gold standards. A prospective study of blunt trauma patients who underwent computed tomography (CT) scan of the chest, abdomen, or both, was performed. Before CT scan, an US examination was performed specifically to identify free fluid in the thorax. The CT scan findings were used as the gold standard for validation of US results. From July 1998 to June 1999, 142 of 155 patients who underwent US and CT scan for evaluation of blunt trauma were included in this study. The CT scan identified 16 cases of hemothorax among these patients. ED US resulted in 2 true-positive, 2 false-positive, 14 false-negative, and 124 true-negative findings. ED US was 12.5% sensitive and 98.4% specific. ED US did not detect small-volume hemothorax identified by CT scan. Future research should focus on further defining the size of hemothorax appreciable with ED US, with increased attention paid to the type of gold standard implemented for its evaluation.

  View details for DOI 10.1016/S0736-4679(03)00168-9

  View details for Web of Science ID 000184520700010

  View details for PubMedID 12902006

• Fluid-filled bowel mimicking hemoperitoneum: A false-positive finding during sonographic evaluation for trauma JOURNAL OF EMERGENCY MEDICINE Kendall, J. L., Ramos, J. P. 2003; 25 (1): 79-82

  Abstract

  This case report describes a patient who presented to the Emergency Department (ED) after a high-speed motor vehicle crash (MVC), whose initial ultrasound examination was interpreted as being positive for fluid in Morison's pouch. Subsequent ultrasound examinations and computed tomography scans further delineated this finding to be fluid-filled bowel juxtaposed between the liver and right kidney. With greater implementation of ED ultrasound, it is important to identify entities that cause false-positive and false-negative examinations.

  View details for DOI 10.1016/S0736-4679(03)00128-8

  View details for Web of Science ID 000184136500014

  View details for PubMedID 12865113

• Penetrating neck trauma EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Kendall, J. L., Anglin, D., Demetriades, D. 1998; 16 (1): 85-+

  Abstract

  Penetrating neck trauma can pose significant diagnostic and therapeutic challenges for emergency physicians. Factors contributing to these problems are complex anatomy, proximity of vital structures, and potential for rapid deterioration of airway, vascular, or neurologic injuries. Other contributing factors are the lack of consensus in the literature regarding appropriate evaluation and management of penetrating neck injuries, and insufficient resources or experienced personnel at some institutions. This review focuses on the key components of the history and physical examinations that allow for an assessment of the severity and type of structures involved. In addition, current methods of airway management, as well as ways to manage penetrating neck trauma efficiently and cost effectively, are discussed.

  View details for DOI 10.1016/S0733-8627(05)70350-3

  View details for Web of Science ID 000073108000008

  View details for PubMedID 9496316