ACEP 2024 Conference Recap - Emergency Ultrasound

The American College of Emergency Physicians (ACEP) hosted its 2024 Scientific Assembly from September 29 to October 2, 2024, at the Mandalay Bay Convention Center in Las Vegas, NV. This conference featured a variety of educational tracks tailored to enhance all aspects of emergency medicine practice.

Today, we will be focusing on the research presented at ACEP24 that utilizes ultrasound in the emergency department. This research includes the assessment of rotator cuff tears, diagnosis of heart failure, evaluation for colitis and diverticulitis, and much more.

Below, we highlight some of the key findings from research presented at ACEP24.

Novice Point-of-Care Ultrasound for the Diagnosis of Acute Dyspnea in the Emergency Department

Dyspnea is a common reason for patients to seek care in the emergency department (ED). While the use of Point-of-Care Ultrasound (POCUS) to diagnose the underlying cause of dyspnea has been studied, the potential prognostic value of POCUS performed by a novice sonographer remains unclear. This study aimed to assess the diagnostic accuracy of POCUS exams conducted by a medical student for various causes of dyspnea.
The results of the study showed that POCUS exams performed by a medical student were able to accurately diagnose conditions such as asthma, COPD, acute heart failure, and pneumonia. This suggests that medical student-conducted POCUS exams could be utilized for risk stratification, helping to identify patients who may benefit from further diagnostic imaging.
Summary

A Multipatient Simulation-Based Program to Train Emergency Medicine Residents in the Rapid Ultrasound for SHock (RUSH) Exam

Point-of-care ultrasound (POCUS) is a valuable tool commonly utilized for rapid diagnostic assessment of hemodynamically unstable patients. The Rapid Ultrasound for Shock and Hypotension (RUSH) exam provides physicians with a systematic approach to identify POCUS findings indicative of shock at the bedside. In order to evaluate emergency medicine (EM) resident learners’ proficiency in POCUS image acquisition, interpretation skills, and comfort level in utilizing the RUSH exam for shock assessment, a simulation session was developed.
The researchers designed a simulation-based learning experience focused on POCUS training, specifically targeting image acquisition and interpretation using the RUSH protocol for shock determination in hemodynamically unstable patients. The results indicated that resident learners, particularly those in their first and second years of training (PGY1 and PGY2), demonstrated significant improvement in confidence levels after participating in this simulation curriculum.
Summary

Current Stance on Focused Cardiac Ultrasound (FOCUS) for Suspected Aortic Dissection by Physicians in Mid-Atlantic Emergency Departments

Focused cardiac ultrasound (FOCUS) for the evaluation of suspected type A aortic dissection (AAD) has garnered significant attention in recent years, yet its widespread adoption remains limited. In this study, a survey was conducted among emergency physicians to assess their utilization and perceptions of FOCUS in the context of AAD. Additionally, the aim was to determine whether providing a manual outlining key data and ultrasound views from existing literature could enhance physicians’ comfort levels with the technique.
This is the first study to investigate emergency physicians’ attitudes towards FOCUS for AAD. The findings revealed that while awareness of the technique is high, its actual utilization is suboptimal. This discrepancy may be attributed to a lack of confidence in interpreting the literature and effectively teaching the technique to colleagues.
Summary

Retrospective Analysis on the Current Use of Bedside Ultrasound in the Diagnosis of Acute Heart Failure in the Emergency Department

This study was conducted to assess the utilization patterns of point-of-care ultrasound (POCUS) for diagnosing acute heart failure (AHF) in a suburban community emergency department (ED) with an emergency medicine residency program where POCUS is a standard component of the training. According to the current guidelines from the American College of Emergency Physicians (ACEP), a combination of history, physical examination, and lung ultrasound is recommended for aiding in the diagnosis of AHF in cases of clinical uncertainty.
The results of this study revealed that among the AHF admissions examined, the most common combination of POCUS studies performed was heart and lung ultrasound, followed by heart, lungs, and inferior vena cava (IVC). When looking at individual POCUS studies, cardiac ultrasound was the most frequently conducted, with lung ultrasound coming in second. The analysis of kappa agreement showed that emergency physicians’ estimates of left ventricular ejection fraction (LVEF) had fair to moderate agreement with the results of echocardiograms performed by cardiologists.
Summary

The Supra Short Ultrasound Protocol to Assess for Rotator Cuff Tears in the Emergency Department: A Pilot Trial

Patients presenting to the emergency department (ED) with shoulder pain often receive a diagnosis of “shoulder pain” if an x-ray does not provide a definitive diagnosis. Subsequently, these patients are typically referred for outpatient magnetic resonance imaging (MRI), which can be costly and challenging to access for some individuals. Despite the availability of ultrasound in the ED, point-of-care ultrasound is seldom utilized to assess the rotator cuff, potentially due to the extensive training required for traditional shoulder ultrasound. The aim of this study was to develop and evaluate the accuracy of a simplified shoulder ultrasound protocol specifically designed for diagnosing rotator cuff tears in the ED.
Following minimal training, emergency physicians successfully learned how to perform the supra-short ultrasound protocol and conducted scans efficiently. However, their ability to identify supraspinatus tears was only moderately accurate. Therefore, further training on identifying pathology would be necessary before implementing this protocol for diagnostic purposes.
Summary

Seeing Clearly: Can Emergency Physicians Use Point-of-Care Ultrasound to Identify Mac on vs. Mac off Retinal Detachment?

Early detection of Retinal Detachment (RD) is crucial in improving the success rate of retinal reattachment procedures and visual outcomes, especially before the macula is affected. The primary objective of this study is to assess the proficiency of emergency physicians in identifying the status of the macula using point-of-care ultrasound images in patients with RD.
The results of the study indicate that emergency physicians showed moderate accuracy in distinguishing between macula-on and macula-off RD from Posterior Vitreous Detachment (PVD) using point-of-care ocular ultrasound. This highlights the importance of training and education for emergency physicians in recognizing and diagnosing RD promptly to improve patient outcomes.
Summary

Diagnostic Accuracy of Ocular Pathology by Emergency Physicians Comparing Ocular Ultrasound and Digital Fundoscopic Imaging

The objective of this study was to compare the accuracy of Emergency Physicians (EPs) in interpreting Digital Retinal Imaging (DRI) and Ocular Ultrasound (OcUS) for both normal and pathological conditions. Furthermore, the study aimed to investigate whether the level of training had any impact on the accuracy of interpretation across these modalities.
The results of this study indicate that EPs exhibit a higher overall accuracy in diagnosing ocular pathologies using OcUS as opposed to DRI. These findings suggest that a comprehensive approach to ocular diagnostics, focusing on enhancing EPs’ proficiency in both OcUS and DRI, may prove to be advantageous.
Summary

The Use of Point-Of-Care-Ultrasound in Evaluating for Colitis and Diverticulitis in the Emergency Department

Acute diverticulitis and colitis are frequently diagnosed conditions in the emergency department (ED). While small studies have highlighted the effectiveness of point-of-care ultrasound (POCUS) in assessing bowel pathology, there is a lack of large prospective studies in this area. To address this gap, we conducted a prospective study to investigate the utility of POCUS in evaluating patients with suspected diverticulitis and/or colitis in the ED. The primary objective of our study was to assess the accuracy, sensitivity, and specificity of POCUS in diagnosing diverticulitis, complicated diverticulitis, and colitis in ED patients presenting with abdominal pain.
The use of POCUS for evaluating bowel pathology is gaining traction in emergency medicine. Our findings indicate that POCUS is highly accurate in diagnosing both diverticulitis and colitis, suggesting that it should be considered as the initial imaging modality for this patient population.
Summary

To Do or Not to Do? Qualitative methods for Ultrasound Guided Subclavian in the Emergency Department

The aim of this study was to assess provider behaviors related to subclavian vein cannulation and to conduct qualitative interviews in order to gain a comprehensive understanding of current practices. This understanding will help in selecting implementation strategies to promote the use of ultrasound-guided subclavian vein cannulation (UGSCv) among Emergency Physicians (EPs).
Our qualitative analysis has confirmed the barriers and facilitators that were previously identified, providing us with a deeper insight into why these barriers and facilitators exist in our Emergency Department (ED). This knowledge will be instrumental in developing evidence-based and targeted strategies to enhance the adoption of UGSCv, thereby equipping EPs with a wider range of skills and capabilities.
Summary

Evaluating the Utility of Pelvic Ultrasound Following a Negative CT Pelvis in Women Presenting to the Emergency Room with Abdominal Pain

Assessing the effectiveness of pelvic ultrasound (US) conducted within 24 hours after a CT scan of the abdomen and pelvis (CTAP) in the emergency department (ED) to detect emergent and urgent pelvic gynecological issues when the CT Pelvis does not show any significant findings. The hypothesis put forth by the researchers is that in cases where the CT pelvis does not indicate any notable pelvic pathology, a subsequent urgent pelvic US will also not reveal any emergent issues.
It is unlikely that performing a pelvic ultrasound within 24 hours of a negative CT scan of the pelvis will alter the management of patients in the emergency department or surgical setting.
Summary

ACEP24 probated a wonderful opportunity to engage with peers and learn about the latest innovations. We recommend checking out ACEP’s free issue which includes all of the abstracts located here. We look forward to ACEP25 in Salt Lake City!

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ACEP 2024 Conference Recap – Emergency Ultrasound