Journal Article > ResearchAbstract Only
Journal of Ultrasound in Medicine. 7 March 2025; DOI:10.1002/jum.16679
Ricci A, Lindsay D, Schwanfelder C, Stratta E, Lee M, et al.
Journal of Ultrasound in Medicine. 7 March 2025; DOI:10.1002/jum.16679
OBJECTIVES
The main objective of this study was to implement an online pediatric case‐based POCUS course in low‐resource medical settings and examine learning outcomes and feasibility.
METHODS
This was a multicenter prospective cohort study conducted in a convenience sample of clinicians affiliated with Médecins Sans Frontières (MSF) training sites. MSF POCUS trainers provided the standard hands‐on, on‐site POCUS training and supplemented this with access to a web‐based course. Participants provided diagnoses for 400 image‐based POCUS cases from four common pediatric POCUS applications until they achieved the mastery learning standard of 90% accuracy, sensitivity (cases with pathology), and specificity (cases without pathology). Each participant also completed a course evaluation.
RESULTS
From 10 MSF sites, 110 clinicians completed 82,206 cases. There were significant learning gains across the POCUS applications with respect to accuracy (delta 14.2%; 95% CI 13.1, 15.2), sensitivity (delta 13.2%; 95% CI 12.1, 14.2), and specificity (delta 13.8%; 95% CI 12.7, 15.0). Furthermore, 90 (81.8%) achieved the mastery learning standard in at least one application, and 69 (62.7%) completed a course evaluation on at least one application for a total of 231 evaluations. Of these, 206 (89.2%) agreed/strongly agreed that the experience had relevance to their practice, met expectations, and had a positive user design. However, 59/110 (53.6%) clinicians reported a lack of protected time, and 54/110 (49.0%) identified challenges with accessing internet/hardware.
CONCLUSIONS
In resource‐limited MSF settings, implementing web‐based POCUS case practice demonstrated successful learning outcomes despite approximately half of the participants encountering significant technical challenges.
Journal Article > ResearchFull Text
J Clin Med. 2 June 2024; Volume 13 (Issue 11); 3282.; DOI:10.3390/jcm13113282
Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, et al.
J Clin Med. 2 June 2024; Volume 13 (Issue 11); 3282.; DOI:10.3390/jcm13113282
BACKGROUND
During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes.
METHODS
We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13).
CONCLUSIONS
Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes.
METHODS
We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13).
CONCLUSIONS
Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
Conference Material > Poster
Niykayo LF, Mahajan R, Sagrado MJ, Ajack YBP, Chol BT, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/CO9XKuY
Conference Material > Poster
Phillip E, Adede J, Onduto S, Ochola C, Simba R, et al.
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/w8leOu
Conference Material > Poster
Branthwaite C, Alasri H, Naif M, Schwanfelder C
MSF Paediatric Days 2024. 3 May 2024; DOI:10.57740/mhQfPz4Ph
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 27 January 2024; Volume 2024 (Issue 1); omad147.; DOI:10.1093/omcr/omad147
Phillipo D, Lucas S, Kalunga MP, Inyasi E, Lebba JP, et al.
Oxf Med Case Reports. 27 January 2024; Volume 2024 (Issue 1); omad147.; DOI:10.1093/omcr/omad147
False-negative qualitative Human Chorionic Gonadotropin (hCG) result is a phenomenon in which large amounts of β-hCG are produced by molar pregnancy, oversaturating the test’s assay system and leading to false-negative results known as the ‘prozone phenomenon’ or the ‘hook effect’. This can lead to misdiagnosis and delay in management despite high suspicious clinical and ultrasound findings. We report a case of an 18-year-old female who presented to our health facility with amenorrhea of 16 weeks, lower abdominal pain, soft and large fundal height for gestational age, and cramping with slight per-vaginal bleeding, and a negative urinary pregnancy test (UPT). Based on clinical presentation, ultrasound findings and a positive UPT after urine dilution, molar pregnancy was diagnosed. Aspiration was performed under ultrasound guidance, and follow-up was done as per MSF guidelines. HCPs need to be familiar with some rare cases for which the possibility of finding false-negative UPT is likely.
Journal Article > EditorialFull Text
Pediatr Crit Care Med
. 1 July 2022; Volume 23 (Issue 7); 560-562.; DOI:10.1097/PCC.0000000000002984
Conlon TW, Himebauch AS, Stratta EM, Srinivasan V
Pediatr Crit Care Med
. 1 July 2022; Volume 23 (Issue 7); 560-562.; DOI:10.1097/PCC.0000000000002984
Conference Material > Video
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 7 June 2022; DOI:10.57740/50a1-ba02
Journal Article > ResearchFull Text
Diagnostics (Basel). 22 February 2021; Volume 11 (Issue 2); DOI:10.3390/diagnostics11020373
Mateos Gonzalez M, de Casasola Sanchez G, Munoz FJ, Proud K, Lourdo D, et al.
Diagnostics (Basel). 22 February 2021; Volume 11 (Issue 2); DOI:10.3390/diagnostics11020373
Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.
Journal Article > ResearchAbstract
Cardiol Young. 8 March 2021; DOI:10.1017/S1047951121000834
Muhame RM, Dragulescu A, Nadimpalli A, Martinez D, Bottineau MC, et al.
Cardiol Young. 8 March 2021; DOI:10.1017/S1047951121000834
Background: In resource limited settings, children with cardiac disease present late, have poor outcomes and access to paediatric cardiology programmes is limited. Cardiac point of care ultrasound was introduced at several Médecins Sans Frontières sites to facilitate cardiopulmonary assessment. We describe the spectrum of disease, case management and outcomes of cases reviewed over the Telemedicine platform.
Methods: Previously ultrasound naïve, remotely placed clinical teams received ultrasound training on focussed image acquisition. The Médecins Sans Frontières Telemedicine platform was utilised for remote case and imaging review to diagnose congenital and acquired heart disease and guide management supported by a remotely situated paediatric cardiologist.
Results: Two-hundred thirty-three cases were reviewed between 2016 and 2018. Of 191 who underwent focussed cardiac ultrasound, diagnoses included atrial and ventricular septal defects 11%, atrioventricular septal defects 7%, Tetralogy of Fallot 9%, cardiomyopathy/myocarditis 8%, rheumatic heart disease 8%, isolated pericardiac effusion 6%, complex congenital heart disease 4% and multiple other diagnoses in 15%. In 17%, there was no identifiable abnormality while 15% had inadequate imaging to make a diagnosis. Cardiologist involvement led to management changes in 75% of cases with a diagnosis. Mortality in the entire group was disproportionately higher among neonates (38%, 11/29) and infants (20%, 16/81). There was good agreement on independent review of selected cases between two independent paediatric cardiologists.
Conclusion: Cardiac point of care ultrasound performed by remote clinical teams facilitated diagnosis and influenced management in cases reviewed over a Telemedicine platform. This is a feasible method to support clinical care in resource limited settings.
Methods: Previously ultrasound naïve, remotely placed clinical teams received ultrasound training on focussed image acquisition. The Médecins Sans Frontières Telemedicine platform was utilised for remote case and imaging review to diagnose congenital and acquired heart disease and guide management supported by a remotely situated paediatric cardiologist.
Results: Two-hundred thirty-three cases were reviewed between 2016 and 2018. Of 191 who underwent focussed cardiac ultrasound, diagnoses included atrial and ventricular septal defects 11%, atrioventricular septal defects 7%, Tetralogy of Fallot 9%, cardiomyopathy/myocarditis 8%, rheumatic heart disease 8%, isolated pericardiac effusion 6%, complex congenital heart disease 4% and multiple other diagnoses in 15%. In 17%, there was no identifiable abnormality while 15% had inadequate imaging to make a diagnosis. Cardiologist involvement led to management changes in 75% of cases with a diagnosis. Mortality in the entire group was disproportionately higher among neonates (38%, 11/29) and infants (20%, 16/81). There was good agreement on independent review of selected cases between two independent paediatric cardiologists.
Conclusion: Cardiac point of care ultrasound performed by remote clinical teams facilitated diagnosis and influenced management in cases reviewed over a Telemedicine platform. This is a feasible method to support clinical care in resource limited settings.