Appropriate Use Criteria for Handheld/Pocket Ultrasound Devices.
No authors listed | Ann Emerg Med. 2025 Mar;85(3):e19-e24
DOI: https://doi.org/10.1016/j.annemergmed.2024.11.012
Keywords: Aucun

POLICY STATEMENT

Editorial : Technological advances have allowed miniaturization of ultrasound technology such that point-of-care ultrasound is available for use with modern tablets and smartphones. Since 2009, a multitude of products have become available in the US market for use with both iOS and Android operating systems. These “pocket devices” target both the inhospital and out-of-hospital markets. Some have the ability to store patient data, interface wirelessly with image archival systems, and insert information into electronic health records or electronic workflow solutions. They have demonstrated image quality that is comparable with conventional machines when used by trained physicians and good concordance with computed tomography imaging. With increased accessibility to point-of-care ultrasound, promoting responsible use of these systems is required.

Conclusion : The same applications that have been set as the standard for point-of-care ultrasound practice apply to pocket devices. The American College of Emergency Physicians (ACEP) policy, “Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine,” contains detailed descriptions regarding settings of use, scope of practice, training, credentialing, quality assurance, and reimbursement

Conclusion (proposition de traduction) : Les mêmes utilisations qui ont été définies comme la norme pour la pratique de l'échographie sur le lieu de soins s'appliquent aux appareils de poche. La politique de l'American College of Emergency Physicians (ACEP), « Ultrasound Guidelines : Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine », contient des descriptions détaillées concernant les conditions d'utilisation, le champ d'application, la formation, l'accréditation, l'assurance qualité et le financement.

Pharmacologic Treatment of Acute Attacks of Episodic Migraine: A Systematic Review and Network Meta-analysis for the American College of Physicians.
Gartlehner G, Dobrescu A, Wagner G, Chapman A, Persad E, Nowak C, Klerings I, Neubauer C, Feyertag J, Gadinger A, Thaler K. | Ann Intern Med. 2025 Mar 18
DOI: https://doi.org/10.7326/annals-24-02034
Keywords:

Online ahead of print.

Introduction : Migraine is common, affecting 15% of Americans.
Purpose: To compare benefits and harms of pharmacologic treatments for acute attacks of episodic migraine in adults and assess cost-effectiveness.

Méthode : Three electronic databases searched to October 2024, gray literature, and reference lists.
Study selection: Two investigators independently selected English-language randomized trials.
Data extraction: Single reviewer data extraction with second review. Dual independent risk of bias and certainty of evidence (COE) assessment.

Résultats : Twenty-one head-to-head and 165 placebo-controlled trials were included in meta-analyses and network meta-analyses. Triptans were more effective than acetaminophen (low COE) and nonsteroidal anti-inflammatory drugs (NSAIDs) (high COE) for pain outcomes at 2 hours and pain freedom up to 48 hours. Triptan and acetaminophen combinations were more effective than acetaminophen alone (moderate COE) for pain outcomes at 2 hours and pain freedom up to 48 hours but not more than triptans alone (low COE). Triptan and NSAID combinations were more effective for pain outcomes at 2 hours and pain freedom up to 48 hours compared with acetaminophen (low COE), gepants (low COE), NSAIDs (high COE), and triptan monotherapy (moderate COE). Triptan regimens, however, often had a higher risk for adverse events. One study found triptans more cost-effective than ditans and gepants.
Limitations: Harms assessment was limited to randomized trials. Many comparisons lacked sufficient evidence to draw conclusions.

Conclusion : Triptans and combinations of triptans were more effective than NSAID and acetaminophen alone.

Conclusion (proposition de traduction) : Les triptans et les associations de triptans ont été plus efficaces que les AINS et l'acétaminophène seuls.

Commentaire : Une migraine épisodique aiguë est définie comme 1 à 14 jours de céphalée par mois.
Les données ont montré que les triptans associés aux AINS étaient plus efficaces pour obtenir une absence de douleur ou un soulagement de la douleur après 2 heures, une absence de douleur jusqu'à 48 heures et un moindre besoin de médicaments de secours que l'acétaminophène, les gépants (rimégépant), les AINS et les triptans en monothérapie.
Le comité des lignes directrices cliniques a déterminé que les triptans, les AINS (aspirine, célécoxib, diclofénac, ibuprofène et naproxène), l'acétaminophène et l'association d'un triptan avec un AINS ou de l'acétaminophène étaient efficaces pour traiter la migraine épisodique aiguë modérée à sévère, par rapport au placebo.

Treatment of hyponatremia: comprehension and best clinical practice.
Sumi H, Tominaga N, Fujita Y, Verbalis JG; Electrolyte Winter Seminar Collaborative Group. | Clin Exp Nephrol. 2025 Mar;29(3):249-258
DOI: https://doi.org/10.1007/s10157-024-02606-3  | Télécharger l'article au format  
Keywords: Hyponatremia; Osmotic demyelination syndrome; Overly rapid correction; Treatment.

INVITED REVIEW ARTICLE

Editorial : This review article series on water and electrolyte disorders is based on the 'Electrolyte Winter Seminar' held annually for young nephrologists in Japan. The seminar features dynamic case-based discussions, some of which are included as self-assessment questions in this series. The second article in this series focuses on treatment of hyponatremia, a common water and electrolyte disorder frequently encountered in clinical practice. Hyponatremia presents diagnostic challenges due to its various etiologies and the presence of co-morbidities that affect water and electrolyte homeostasis. Furthermore, limited evidence, including a lack of robust randomized controlled trials, complicates treatment decisions and increases the risk of poor outcomes from inappropriate management of both acute and chronic hyponatremia. This review provides a comprehensive overview of treatment of hyponatremia for better comprehension and improved clinical practice.

Conclusion : Hyponatremia varies among patients and frequently exhibits a heterogeneous pathophysiology, posing difficulty in diagnosing the underlying cause and identifying the optimal treatment accordingly. However, since evidence in the management of hyponatremia is still insufficient, we hope that high-quality evidence based on RCTs comparing specific treatments will accumulate in the near future to enable individualized treatments for patients with hyponatremia. Until such time, we believe that this review will contribute to guiding best clinical practices in the management of hyponatremia.

Conclusion (proposition de traduction) : L'hyponatrémie varie d'un patient à l'autre et présente souvent une physiopathologie hétérogène, ce qui complique le diagnostic de la cause sous-jacente et l'identification du traitement optimal en conséquence. Cependant, comme les preuves de la prise en charge de l'hyponatrémie sont encore insuffisantes, nous espérons que des preuves de haute qualité basées sur des essais contrôlés randomisés comparant des traitements spécifiques s'accumuleront dans un avenir proche pour permettre des traitements individualisés pour les patients souffrant d'hyponatrémie. En attendant, nous pensons que cette revue contribuera à orienter les meilleures pratiques cliniques dans la prise en charge de l'hyponatrémie.

Diagnostic accuracy of prehospital ultrasound in detecting lung injury in patients with trauma: a systematic review and meta-analysis.
Sen JPB, Emerson J, Franklin J. | Emerg Med J. 2025 Mar 25;42(4):256-263
DOI: https://doi.org/10.1136/emermed-2023-213647
Keywords: Ultrasonography; chest; pneumothorax; pre-hospital; research.

Systematic review

Introduction : Ultrasound is now readily available in the prehospital setting and its use has been highlighted as one of the top research priorities in prehospital care. Clinical examination remains the standard care for diagnosing lung injury in the prehospital setting, yet this can be challenging and has poor diagnostic accuracy. This review evaluates the accuracy of prehospital ultrasound for the diagnoses of pneumothorax, haemothorax and pulmonary contusions in patients with trauma.

Méthode :  systematic review and meta-analysis was conducted. MEDLINE/PubMed, CINAHL, Embase and the Cochrane Library were searched. Only papers reporting on the diagnostic accuracy of lung ultrasound for traumatic pneumothorax, haemothorax or pulmonary contusions; in a prehospital or helicopter emergency medical service setting; and with CT or operative findings as a reference standard, were included. Non-English studies or articles that reported on animal studies were excluded. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the methodological quality of the included studies.

Résultats : Six observational studies, four with low risk of bias and two with some concerns, reporting on 1908 thoracic ultrasound examinations in patients with trauma, were included. For pneumothorax, meta-analysis yielded pooled sensitivity of 29% (95% CI 22% to 37%, I²=0%) and pooled specificity of 98% (95% CI 97% to 99%, I²=0%). Insufficient data were reported for a reliable meta-analysis on the presence of haemothorax. Only one study reported on the presence of pulmonary contusions and therefore no analysis was conducted.

Conclusion : Prehospital ultrasound is highly specific but has a lower sensitivity for the presence of pneumothorax when compared with hospital studies. Further research is required, alongside education and training of prehospital providers, to further explore the factors that account for the differences observed in this review.

Conclusion (proposition de traduction) : L'échographie préhospitalière est très spécifique mais a une sensibilité plus faible pour la détection du pneumothorax par rapport aux études hospitalières. Des recherches supplémentaires sont nécessaires, parallèlement à la formation des intervenants préhospitaliers, pour étudier plus en détail les facteurs qui expliquent les différences observées dans cette étude.

Commentaire :  Cette méta-analyse a évalué l'efficacité de l'échographie réalisée avant l'arrivée à l'hôpital pour détecter les lésions pulmonaires chez les patients traumatisés. Les résultats suggèrent que l'échographie préhospitalière est un outil fiable pour la détection précoce des lésions pulmonaires, facilitant ainsi une prise en charge rapide.​

Hyperkalemia management: a multidisciplinary expert panel’s perspective on the role of new potassium binders.
Fonseca C, Garagarza C, Silva G, Caires G, Marques I, Lopes JA, Branco P, Alves R, Ferreira A. | Heart Fail Rev. 2025 Mar;30(2):271-286
DOI: https://doi.org/10.1007/s10741-024-10461-3  | Télécharger l'article au format  
Keywords: Chronic kidney disease; Heart failure; Hyperkalemia; Patiromer; RAASi therapy; Sodium zirconium cyclosilicate.

Article

Editorial : Hyperkalemia is a potentially life-threatening condition frequently encountered in clinical practice, particularly among patients with chronic kidney disease, heart failure, diabetes, and hypertension and those undergoing treatment with renin-angiotensin-aldosterone system inhibitors (RAASi). The management of chronic and acute hyperkalemia is complex and requires timely intervention to prevent severe complications such as cardiac arrhythmias and sudden death. Traditional therapeutic approaches to chronic hyperkalemia, including dietary potassium restriction, use of diuretics, and administration of cation-exchange resins like sodium polystyrene sulfonate, often suffer from limitations like gastrointestinal side effects, variable efficacy, delayed onset of action, and RAASi treatment discontinuation. In recent years, the development of new potassium binders, specifically patiromer and sodium zirconium cyclosilicate (SZC), has revolutionized the management of hyperkalemia. Patiromer, a non-absorbed polymer, binds potassium in the gastrointestinal tract in exchange for calcium, thus facilitating its excretion. SZC operates by exchanging sodium and hydrogen ions for potassium, leading to efficient potassium removal. Both agents have demonstrated rapid and sustained reductions in serum potassium levels, coupled with favorable safety and tolerability profiles, in multiple clinical trials. This review article, authored by a multidisciplinary group of Portuguese experts in hyperkalemia management, provides an in-depth analysis of the efficacy and safety of current therapeutic strategies and highlights the clinical potential of new potassium binders. The introduction of patiromer and SZC offers significant advantages over traditional therapies, providing effective and better-tolerated options for patients. The review highlights the role of these novel agents in contemporary hyperkalemia management and calls for ongoing research to further refine treatment protocols and improve patient outcomes.

Conclusion : Concomitant to the need for well-designed clinical trials, conducting and reporting data from real-world settings is crucial to ensure the true long-term effectiveness and safety of patiromer and SZC. A holistic approach involving the collective expertise of cardiologists, nephrologists, internists, and nutritionists is essential for optimizing HK management and improving the overall quality of care for patients. Clear, evidence-based communication is vital to guide healthcare providers in selecting the most appropriate therapy based on individual patient needs and clinical scenarios, ensuring both effective and safe management of HK across different settings.

Conclusion (proposition de traduction) : Parallèlement à la nécessité de mener des essais cliniques bien conçus, il est essentiel de recueillir et de communiquer des données en situation réelle pour garantir l'efficacité et la sécurité à long terme du patiromère et du cyclosilicate de zirconium sodique. Une approche holistique faisant appel à l'expertise collective des cardiologues, des néphrologues, des internistes et des nutritionnistes est essentielle pour optimiser la prise en charge de l'hyperkaliémie et améliorer la qualité globale des soins prodigués aux patients. Une communication claire et fondée sur des données probantes est essentielle pour guider les professionnels de santé dans le choix du traitement le plus approprié en fonction des besoins individuels des patients et des scénarios cliniques, afin de garantir une prise en charge efficace et sûre de l'hyperkaliémie dans différents contextes.

Prospective Validation and Implementation Pilot Study of an Emergency Department Heart Failure Risk Stratification Tool: STRIDE-HF.
Sax DR, Huang J, Mark DG, Rana JS, Solomon MS, Norris RP, Reed ME. | JACC Heart Fail. 2025 Mar 25:S2213-1779(25)00171-4
DOI: https://doi.org/10.1016/j.jchf.2025.01.018
Keywords: acute heart failure; emergency department; risk stratification.

Original Research

Editorial : The STRIDE-HF (Systematic Tool for Risk Identification and Decision-making in Emergency Heart Failure) emergency department (ED) risk tool was previously found to accurately predict the risk of a 30-day serious adverse event (SAE), including 30-day mortality, cardiopulmonary resuscitation, intra-aortic balloon pump insertion, intubation, new dialysis, myocardial infarction, or coronary revascularization.

Introduction : The aim of this study was to prospectively validate STRIDE-HF across 21 community EDs among patients in the ED with acute heart failure (AHF) from January 1, 2023, to December 31, 2023, and to assess the safety of the real-time use of risk estimates in a 2-ED pilot study.

Méthode : Model area under the receiver operator curve (AUROC) and area under the precision recall curve (AUPRC), sensitivity, specificity, and positive and negative predictive values and likelihood ratios at key clinical thresholds are reported. In the clinical pilot, the rates of 30-day SAEs among patients who were at lower risk by STRIDE-HF and were discharged after ED or observation care were reported.

Résultats : There were 13,274 patients in the ED in the prospective validation; the median age was 76 years, 50.8% were female, and 44.5% were non-White; and 11.4%, 24.8%, 31.9%, and 31.9% of patients were at very low, low, moderate, and high risk, respectively. The 30-day SAE rates among very-low-risk and low-risk patients were 3.4% and 6.7%, respectively, and the 30-day mortality rates were <1% and <2%, respectively. STRIDE-HF was highly sensitive among low-risk patients (97.6%; 95% CI: 96.8%-98.2%); AUROC was 0.75 (95% CI: 0.74-0.76), and AUPRC was 0.43 (95% CI: 0.39-0.44). There were 845 patients in the pilot study; among patients classified by STRIDE-HF criteria as being at very low risk who were discharged, none experienced a 30-day SAE.

Conclusion : STRIDE-HF maintained high predictive accuracy for 30-day SAE in prospective validation in this large, diverse, multicenter cohort; the use of risk estimates in real time safely identified low-risk patients appropriate for discharge.

Conclusion (proposition de traduction) : STRIDE-HF a conservé une grande précision prédictive pour les événements indésirables graves à 30 jours lors de la validation prospective de cette cohorte multicentrique importante et diversifiée ; l'utilisation des estimations de risque en temps réel a permis d'identifier en toute sécurité les patients à faible risque susceptibles d'être autorisés à sortir de l'hôpital.

Commentaire : Cette étude a évalué l'efficacité de l'outil STRIDE-HF pour stratifier le risque des patients se présentant aux urgences avec une insuffisance cardiaque aiguë. Les résultats suggèrent que STRIDE-HF peut aider à identifier les patients à faible risque pouvant être pris en charge en ambulatoire, optimisant ainsi l'utilisation des ressources hospitalières.​

Point-of-care ultrasound diagnosis of acute valvular emergencies.
Stenberg R, Bowling J, Jacquet J, Watkins K, Eggleston J, Hill A, Krizo J. | Am J Emerg Med. 2025 Mar;89:36-50
DOI: https://doi.org/10.1016/j.ajem.2024.11.009  | Télécharger l'article au format  
Keywords: Acute valvular emergency; Critical aortic stenosis; Infective endocarditis; Left ventricular outflow tract obstruction; Mitral regurgitation; Mitral stenosis; Point-of-care ultrasound.

Article

Introduction : Acute valvular emergencies, a time-sensitive diagnosis, are nearly impossible to diagnose without ultrasound, and missing the diagnosis can significantly impact patient outcomes. Many emergency physicians lack access to echo technicians and may be uncomfortable performing the ultrasound themselves. Approaching the paucity of review articles, none of which are focused for the emergency physician, can be quite daunting, even for those with extensive ultrasound training.

Méthode : Our goal is to provide a simple resource for emergency physicians to utilize ultrasound to diagnose acute valvular emergencies. We created a concise review that includes relevance and approach to the diagnosis, complete with live ultrasound images, reference cards, and focused figures for in-the-moment reference.
A team of ultrasound fellowship-trained emergency medicine physicians determined the highest yield emergent conditions and oversaw the project. Each team member reviewed the etiology, incidence, and level of evidentiary support for each condition and then provided a guide to the appropriate procedure and evaluation with relevant additional guidance. An in-house graphics team was consulted to prepare original, concise figures for easy reference. All sections of the manuscript and figures were reviewed for accuracy and ease of use.

Discussion : Critical aortic stenosis, infective endocarditis, left ventricular outflow tract obstruction, mitral stenosis, and mitral regurgitation were identified diagnoses for which ultrasound can provide immediate diagnostic information for emergency physicians.

Conclusion : The use of ultrasound in the emergency department setting is a critical adjunct to care for patients with acute valvular emergencies. One should always consider a comprehensive, cardiology-performed echocardiogram in these scenarios.

Conclusion (proposition de traduction) : L'utilisation de l'échographie dans les services d'urgence est un complément essentiel aux soins prodigués aux patients souffrant d'urgences valvulaires aiguës. Il faut toujours envisager un échocardiogramme complet effectué par un cardiologue dans ces scénarios.