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Article ; Online: Use of Point-of-care Ultrasound for the Seizing Infant: An Adjunct for Detection of Abusive Head Trauma.

Rowland, Jonathan / Fouchia, Dean / Favot, Mark

Clinical practice and cases in emergency medicine

2020 Volume 4, Issue 3, Page(s) 485–486

Abstract: Case presentation: An eight-week-old infant presented to the emergency department in cardiac arrest. Return of spontaneous circulation was obtained and the patient subsequently began seizing. Point-of-care ultrasound of the anterior fontanelle revealed ... ...

Abstract	Case presentation: An eight-week-old infant presented to the emergency department in cardiac arrest. Return of spontaneous circulation was obtained and the patient subsequently began seizing. Point-of-care ultrasound of the anterior fontanelle revealed an extra-axial fluid collection consistent with subdural hematoma (SDH). Discussion: Abusive head trauma is still frequently missed on initial presentation. In addition to validated screening clinical prediction rules, point-of-care cranial ultrasound can be used as a noninvasive adjunct for detection of SDH related to abusive head trauma in infants with an open fontanelle.
Language	English
Publishing date	2020-09-18
Publishing country	United States
Document type	Journal Article
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2020.6.48207
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Utilization of point-of-care ultrasound among graduates of a 4-year longitudinal medical school ultrasound curriculum.

Nguyen, Andy Phan / Saadat, Soheil / Nguyen, Michelle Thao / Desai, Monica Devang / Rowland, Jonathan Wesley / Fox, John Christian

Clinical and experimental emergency medicine

2023 Volume 10, Issue 2, Page(s) 224–229

Abstract: Objective: In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, ... ...

Abstract	Objective: In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, Irvine alumni. Methods: We surveyed University of California, Irvine alumni from the class of 2011 and beyond. Survey questions included POCUS reliance, frequency of use, and comfort with image acquisition and interpretation compared with peers. The primary outcomes were self-reported comfort and reliance on POCUS. Results: We received 93 responses from 624 surveyed alumni (response rate, 14.9%), of which 87 were analyzed. Although 46 respondents (52.9%) reported more reliance on POCUS, three (3.4%) relied on it less than their peers. At the same time, 72 (82.7%) and 67 (77.0%) felt more comfortable than their colleagues in obtaining and interpreting POCUS, respectively. No respondents felt less comfortable obtaining or interpreting POCUS than their peers. The frequency of POCUS use correlated directly with the frequency with which POCUS changed the responder's case management (rho, 0.860; P<0.001). POCUS reliance also correlated with respondents' comfort level in obtaining (rho, 0.321; P<0.001) and interpreting (rho, 0.378; P<0.001) POCUS results. Conclusion: University of California, Irvine graduates had higher reliance on POCUS than peers in their respective specialties. Their POCUS findings frequently changed their case management.
Language	English
Publishing date	2023-01-30
Publishing country	Korea (South)
Document type	Journal Article
ISSN	2383-4625
ISSN	2383-4625
DOI	10.15441/ceem.22.357
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Optimal Image Gain Intensity of Point-of-care Ultrasound when Screening for Ocular Abnormalities in the Emergency Department.

Chang, Melissa / Finney, Nicole / Baker, Jessa / Rowland, Jonathan / Gupta, Shreya / Sarsour, Reem / Saadat, Soheil / Fox, John C

The western journal of emergency medicine

2023 Volume 24, Issue 3, Page(s) 622–628

Abstract: Introduction: Point-of-care ultrasound (POCUS) plays a pivotal role in evaluating ocular complaints in the emergency department (ED). The rapid and non-invasive nature of ocular POCUS makes it a safe and informative imaging modality. Previous studies ... ...

Abstract	Introduction: Point-of-care ultrasound (POCUS) plays a pivotal role in evaluating ocular complaints in the emergency department (ED). The rapid and non-invasive nature of ocular POCUS makes it a safe and informative imaging modality. Previous studies have investigated using ocular POCUS to diagnose posterior vitreous detachment (PVD), vitreous hemorrhage (VH), and retinal detachment (RD); however, there are few studies that assess image optimization techniques and how they impact the overall accuracy of ocular POCUS. Methods: We performed a retrospective review of ED patients who received ocular POCUS examinations and ophthalmology consultations as part of their evaluation for eye complaints at our urban, Level I trauma center ED from November 2017-January 2021. Of 706 exams, 383 qualified for the study. In this study we primarily investigated how stratified gain levels impact the accuracy of ocular POCUS for detection of any posterior chamber pathology and, secondarily, whether stratified gain levels impact the accuracy of detecting RD, VH, and PVD specifically. Results: The images were found to have an overall sensitivity of 81% (76-86%), specificity of 82% (76-88%), positive predictive value (PPV) of 86% (81-91%), and negative predictive value (NPV) of 77% (70-83%). Images acquired with a gain of (25, 50] had a sensitivity of 71% (61-80%), specificity of 95% (85-99%), PPV of 96% (88-99%), and NPV of 68% (56-78%). Images acquired with a gain of (50, 75] had a sensitivity of 85% (73-93%), specificity of 85% (72-93%), PPV of 86% (75-94%), and NPV of 83% (70-92%). Images acquired with a high gain (75, 100] had a sensitivity of 91% (82-97%), specificity of 67% (53-79%), PPV of 78% (68-86%), and NPV of 86% (72-95%). Conclusion: In the ED setting, high (75, 100] gain on ocular POCUS scanning has a higher degree of sensitivity for detecting any posterior chamber abnormality, as compared to low (25, 50] gain levels. Thus, incorporating the use of high gain for ocular POCUS exams produces a more effective tool for ocular pathologies in acute care settings and may be particularly valuable in resource-limited settings.
MeSH term(s)	Humans ; Point-of-Care Systems ; Sensitivity and Specificity ; Ultrasonography/methods ; Eye/diagnostic imaging ; Retinal Detachment/diagnostic imaging ; Vitreous Detachment ; Emergency Service, Hospital
Language	English
Publishing date	2023-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.59714
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Adult Male with Left Arm Pain and Swelling.

Rowland, Jonathan / Traill, Lauren / Favot, Mark

Clinical practice and cases in emergency medicine

2018 Volume 2, Issue 4, Page(s) 371–372

Language	English
Publishing date	2018-08-16
Publishing country	United States
Document type	Journal Article
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2018.7.39151
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Amplitude-integrated EEG in infants with neonatal abstinence syndrome.

Rana, Divya / Pollard, Leann / Rowland, Jonathan / Dhanireddy, Ramasubbareddy / Pourcyrous, Massroor

Journal of neonatal-perinatal medicine

2019 Volume 12, Issue 4, Page(s) 391–397

Abstract: Background: To describe amplitude-integrated encephalogram (aEEG) characteristics of neonates with neonatal abstinence syndrome (NAS).: Methods: This is a prospective observational study. Newborns exposed to prenatal opioids and their gestational ... ...

Abstract	Background: To describe amplitude-integrated encephalogram (aEEG) characteristics of neonates with neonatal abstinence syndrome (NAS). Methods: This is a prospective observational study. Newborns exposed to prenatal opioids and their gestational matched controls were included. A single-channel aEEG was obtained using Olympic 6000 CFM monitor. The background activity (continuous/discontinuous), the amplitudes (μV) and the presence of sleep-wake cycle (SWC) were documented. Results: A total of 59 infants, 23 with NAS and 36 controls were enrolled. All aEEG were completed within 48 hours of life prior to initiation of treatment. Birth weight and gestational age were similar in both groups. An aEEG was abnormal (discontinuous pattern and/or absent SWC) in 78 % (18/23) of infants with NAS versus only 25% in control group (9/36), [OR 10.8, CI (2.7-46.5) P < 0.001]. 61% of infants with NAS had discontinuous pattern [OR 7.8, CI (2-32) P = 0.001] and 39% had absence of sleep-wake cycle [OR 7.1, CI (1.4-39.4) P = 0.007]. Conclusions: A majority of infants with NAS have abnormal aEEG activity.
MeSH term(s)	Adult ; Brain/blood supply ; Brain/diagnostic imaging ; Brain/physiopathology ; Electroencephalography/instrumentation ; Female ; Gestational Age ; Guidelines as Topic ; Humans ; Infant, Newborn ; Infant, Premature ; Male ; Monitoring, Physiologic ; Neonatal Abstinence Syndrome/diagnostic imaging ; Neonatal Abstinence Syndrome/physiopathology ; Pilot Projects ; Pregnancy ; Prospective Studies ; Sleep Disorders, Circadian Rhythm/diagnostic imaging ; Sleep Disorders, Circadian Rhythm/physiopathology
Language	English
Publishing date	2019-07-29
Publishing country	Netherlands
Document type	Journal Article ; Observational Study
ZDB-ID	2435387-5
ISSN	1878-4429 ; 1934-5798
ISSN (online)	1878-4429
ISSN	1934-5798
DOI	10.3233/NPM-1834
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Point-of-Care Lung Ultrasound for Detecting Severe Presentations of Coronavirus Disease 2019 in the Emergency Department: A Retrospective Analysis.

Favot, Mark / Malik, Adrienne / Rowland, Jonathan / Haber, Brian / Ehrman, Robert / Harrison, Nicholas

Critical care explorations

2020 Volume 2, Issue 8, Page(s) e0176

Abstract: Objectives: Analyze the diagnostic test characteristics of point-of-care lung ultrasound for patients suspected to have novel coronavirus disease 2019.: Design: Retrospective cohort.: Setting: Two emergency departments in Detroit, Michigan, United ...

Abstract	Objectives: Analyze the diagnostic test characteristics of point-of-care lung ultrasound for patients suspected to have novel coronavirus disease 2019. Design: Retrospective cohort. Setting: Two emergency departments in Detroit, Michigan, United States, during a local coronavirus disease 2019 outbreak (March 2020 to April 2020). Patients: Emergency department patients receiving lung ultrasound for clinical suspicion of coronavirus disease 2019 during the study period. Interventions: None, observational analysis only. Measurements and main results: By a reference standard of serial reverse transcriptase-polymerase chain reactions, 42 patients were coronavirus disease 2019 positive, 16 negative, and eight untested (test results lost, died prior to testing, and/or did not meet hospital guidelines for rationing of reverse transcriptase-polymerase chain reaction tests). Thirty-three percent, 44%, 38%, and 17% had mortality, ICU admission, intubation, and venous or arterial thromboembolism, respectively. Receiver operating characteristics, area under the curve, sensitivity, and specificity with 95% CIs were calculated for five lung ultrasound patterns coded by a blinded reviewer and chest radiograph. Chest radiograph had area under the curve = 0.66 (95% CI, 0.54-0.79), 74% sensitivity (95% CI, 48-93%), and 53% specificity (95% CI, 32-75%). Two lung ultrasound patterns had a statistically significant area under the curve: symmetric bilateral pulmonary edema (area under the curve, 0.57; 95% CI, 0.50-0.64), and a nondependent bilateral pulmonary edema pattern (edema in superior lung ≥ inferior lung and no pleural effusion; area under the curve, 0.73; 95% CI, 0.68-0.90). Chest radiograph plus the nondependent bilateral pulmonary edema pattern showed a statistically improved area under the curve (0.80; 95% CI, 0.68-0.90) compared to either alone, but at the ideal cutoff had sensitivity and specificity equivalent to nondependent bilateral pulmonary edema only (69% and 77%, respectively). The strongest combination of clinical, chest radiograph, and lung ultrasound factors for diagnosis was nondependent bilateral pulmonary edema pattern with temperature and oxygen saturation (area under the curve, 0.86; 95% CI, 0.76-0.94; sensitivity = 77% [58-93%]; specificity = 76% [53-94%] at the ideal cutoff), which was superior to chest radiograph alone. Conclusions: Lung ultrasound diagnosed severe presentations of coronavirus disease 2019 with similar sensitivity to chest radiograph, CT, and reverse transcriptase-polymerase chain reaction (on first testing) and improved specificity compared to chest radiograph. Diagnostically useful lung ultrasound patterns differed from those hypothesized by previous, nonanalytical, reports (case series and expert opinion), and should be evaluated in a rigorous prospective study.
Keywords	covid19
Language	English
Publishing date	2020-07-31
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000176
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Article: The Use of Handheld Ultrasound Devices in Emergency Medicine.

Malik, Adrienne N / Rowland, Jonathan / Haber, Brian D / Thom, Stephanie / Jackson, Bradley / Volk, Bryce / Ehrman, Robert R

Current emergency and hospital medicine reports

2021 Volume 9, Issue 3, Page(s) 73–81

Abstract: Purpose of review: Ultraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these ...

Abstract	Purpose of review: Ultraportable handheld ultrasound (HHU) devices are being rapidly adopted by emergency medicine (EM) physicians. Though knowledge of the breadth of their utility and functionality is still limited compared to cart-based systems, these machines are becoming more common due to ease-of-use, extreme affordability, and improving technology. Recent findings: Images obtained with HHU are comparable to those obtained with traditional machines but create unique issues regarding billing and data management. HHU devices are increasingly used successfully to augment the education of practitioners-in-training, by emergency physicians in austere environments, and in the burgeoning fields of "tele-ultrasound" and augmented reality scanning. Summary: This review seeks to describe the current state of use of HHU devices in the emergency department (ED) including device overview, institutional concerns, unique areas of use, recent literature since their adoption into clinical EM, and their future potential.
Language	English
Publishing date	2021-05-11
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2167-4884
ISSN	2167-4884
DOI	10.1007/s40138-021-00229-6
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Point-of-Care Lung Ultrasound for Detecting Severe Presentations of Coronavirus Disease 2019 in the Emergency Department: A Retrospective Analysis

Favot, Mark / Malik, Adrienne / Rowland, Jonathan / Haber, Brian / Ehrman, Robert / Harrison, Nicholas

Crit Care Explor

Abstract: Objectives: Analyze the diagnostic test characteristics of point-of-care lung ultrasound for patients suspected to have novel coronavirus disease 2019. Design: Retrospective cohort. Setting: Two emergency departments in Detroit, Michigan, United States, ... ...

Abstract	Objectives: Analyze the diagnostic test characteristics of point-of-care lung ultrasound for patients suspected to have novel coronavirus disease 2019. Design: Retrospective cohort. Setting: Two emergency departments in Detroit, Michigan, United States, during a local coronavirus disease 2019 outbreak (March 2020 to April 2020). Patients: Emergency department patients receiving lung ultrasound for clinical suspicion of coronavirus disease 2019 during the study period. Interventions: None, observational analysis only. Measurements and Main Results: By a reference standard of serial reverse transcriptase-polymerase chain reactions, 42 patients were coronavirus disease 2019 positive, 16 negative, and eight untested (test results lost, died prior to testing, and/or did not meet hospital guidelines for rationing of reverse transcriptase-polymerase chain reaction tests). Thirty-three percent, 44%, 38%, and 17% had mortality, ICU admission, intubation, and venous or arterial thromboembolism, respectively. Receiver operating characteristics, area under the curve, sensitivity, and specificity with 95% CIs were calculated for five lung ultrasound patterns coded by a blinded reviewer and chest radiograph. Chest radiograph had area under the curve = 0.66 (95% CI, 0.54-0.79), 74% sensitivity (95% CI, 48-93%), and 53% specificity (95% CI, 32-75%). Two lung ultrasound patterns had a statistically significant area under the curve: symmetric bilateral pulmonary edema (area under the curve, 0.57; 95% CI, 0.50-0.64), and a nondependent bilateral pulmonary edema pattern (edema in superior lung ≥ inferior lung and no pleural effusion; area under the curve, 0.73; 95% CI, 0.68-0.90). Chest radiograph plus the nondependent bilateral pulmonary edema pattern showed a statistically improved area under the curve (0.80; 95% CI, 0.68-0.90) compared to either alone, but at the ideal cutoff had sensitivity and specificity equivalent to nondependent bilateral pulmonary edema only (69% and 77%, respectively). The strongest combination of clinical, chest radiograph, and lung ultrasound factors for diagnosis was nondependent bilateral pulmonary edema pattern with temperature and oxygen saturation (area under the curve, 0.86; 95% CI, 0.76-0.94; sensitivity = 77% [58-93%]; specificity = 76% [53-94%] at the ideal cutoff), which was superior to chest radiograph alone. Conclusions: Lung ultrasound diagnosed severe presentations of coronavirus disease 2019 with similar sensitivity to chest radiograph, CT, and reverse transcriptase-polymerase chain reaction (on first testing) and improved specificity compared to chest radiograph. Diagnostically useful lung ultrasound patterns differed from those hypothesized by previous, nonanalytical, reports (case series and expert opinion), and should be evaluated in a rigorous prospective study.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #695631
Database	COVID19

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Article ; Online: CDX2 in congenital gut gastric-type heteroplasia and intestinal-type Meckel diverticula.

Martin, Elisabeth / Vanier, Marie / Tavian, Manuela / Guerin, Eric / Domon-Dell, Claire / Duluc, Isabelle / Gross, Isabelle / Rowland, Jonathan / Kim, Sunghoon / Freund, Jean-Noël

Pediatrics

2010 Volume 126, Issue 3, Page(s) e723–7

Abstract: The mechanisms that determine organ identity along the digestive tract in humans are poorly understood. Here we describe the rare case of a young patient who presented with congenital gastric-type heteroplasia in the midjejunum. The lesions, located ... ...

Abstract	The mechanisms that determine organ identity along the digestive tract in humans are poorly understood. Here we describe the rare case of a young patient who presented with congenital gastric-type heteroplasia in the midjejunum. The lesions, located along the antimesenteric midline of the gut, were made of histologically and functionally normal gastric epithelium without inflammation or in situ/invasive carcinoma. They resembled the anatomy of the lesions developing in the mouse gut as a result of haploinsufficiency of the Cdx2 homeobox gene. The lesions were devoid of CDX2 but without mutation in the coding sequence or in a cis-regulatory element required for intestine-specific expression. Combining these data with the CDX2 expression pattern established from human embryos and cases of Meckel diverticula, we propose a scenario for this patient's presentation, in which CDX2 was missing at the site of ventral closure during gut morphogenesis, with subsequent default differentiation into gastric instead of intestinal tissue. Altogether, these observations argue in favor of a pivotal role played by CDX2 in determining intestinal identity during human embryonic development, as previously shown experimentally in mice.
MeSH term(s)	CDX2 Transcription Factor ; Child ; Homeodomain Proteins/physiology ; Humans ; Male ; Meckel Diverticulum/etiology ; Meckel Diverticulum/pathology
Chemical Substances	CDX2 Transcription Factor ; CDX2 protein, human ; Homeodomain Proteins
Language	English
Publishing date	2010-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2009-3512
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