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.

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.​

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.​