Chest Disorders Clinical Trial
Official title:
Emergency Thoracic Ultrasound and Clinical Risk Management
Clinical risk assessment and management is mostly relevant in emergency. Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in Emergency diagnosis of pneumonia, pleural effusion and pneumothorax. Investigators investigated CXR "unforeseen diagnosis", provided by TUS, exploring usefulness and sustainability of telementoring aimed at the management of clinical risk. This observational report includes a period of six months with a proactive concurrent adjunctive telementoring in TUS diagnosis using freely available smartphone applications for the transfer of images and movies.
The present study describes a six months period of specialist activity of an Emergency
Department physician. The aim is to display the performance in the subsets of difficult or
unexpected thoracic ultrasound imaging performed by TUS, in a context with the prompt
availability of all radiological facilities. The interaction of TUS telementoring, using
WhatsApp® or Skype®, provided by another colleague, in another city and hospital, with a
greater specific expertise in TUS, was devised to assure a concurrent mentorship by the
School. This training has included a subsequent revaluation of clinical cases by the
Ultrasound Course Lecturer in TUS and by the Director of the School of Clinical Ultrasound,
with a reappraisal overview of all the available information. The approach was clinical and
instrumental, and included:
A. clinical history; B. clinical examination of chest, neck, joints and abdomen; C.
sequential ultrasound examination of the abdomen, thorax, pericardium; D. focus on pain
symptoms: of chest, abdomen (with or without distention), lumbar region, neck; E. focus on
dyspnea and/or cough and/or fever with detection of humid or dry lung sounds, chest
dullness, of heart and/or pleura-pericardial sounds, and/or jugular congestion, checking
also the mobility of the diaphragm and evaluating the collapsibility of the cava vein.
TUS was generally conducted with the patient in a sitting position, although the few
patients (predominantly children), likely to experience severe discomfort during the
procedure, were scanned in a semi-supine position. A systematic examination of all
intercostal spaces was performed and TUS images, if present, were assessed for the number,
location, shape, size, and breath-dependent changes in consolidation areas. Two main types
of pattern of lung consolidation attributable to pneumonia were defined: hypoechoic
consolidation and mixed consolidation. The presence of air bronchogram, fluid bronchogram,
and basal pleural effusion was also reported. The size of the consolidation area was
measured longitudinally and transversally, using the longest measurement, i.e., the maximal
length of the consolidation area visible by TUS, for data analysis. For the purpose of this
report, details on the measurements are not detailed.
The second opinion was provided outside the Hospital facility by a mentor (FMT), expert in
Clinical Ultrasound, answering to the questions related to the images of videoclips of the
actual patient in emergency. Images and movies were sent by WhatsApp. Reappraisal was
performed subsequently, using all the available imaging - photos and videoclips, the
clinical records and the outcome information, as obtainable by a short-term follow-up.
;
Observational Model: Case-Only, Time Perspective: Prospective
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Recruiting |
NCT03022942 -
Efficacy of Costal Mobilization Techniques and Manual Diaphragm Release Technique in Patients COPD
|
N/A |