Maui Emergencies in Medicine Conference 2022 Abstracts

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A Double-blinded Comparison of Low-cost Ultrasound Media: A Simulation and In-vivo Analysis Sasha Reid, Anthony Santarelli, Heesun Choi Kingman Regional Medical Center, Kingman, AZ, USA Introduction: Point-of-care ultrasound is a vital real-time diagnostic tool due to its portability, accuracy, and ease of use. A barrier to its widespread use is the cost of ultrasound gel (USG). Therefore, many resource-poor areas are left without viable alternatives for commercialized USG. The primary objective of this study was to determine the diagnostic image quality of low-cost and readily available USG alternatives. The secondary objective was to determine the clinical efficacy among diagnosticians of varying degrees of expertise. Methods: A volunteer was recruited to participate as a human model. Two diagnosticians (one fellowship trained and one resident physician) generated the views of the right upper quadrant, left upper quadrant, and gallbladder with USG and five household gel analogs (water, isopropyl alcohol, mineral oil, lotion, conditioner, and Aloe vera gel). The images then were imported into the ImageJ image processing software. Measures taken include the diameter of the anterior wall of the gallbladder, inferior point of the splenorenal recess, and inferior point of Morrison’s pouch. Image quality was assessed through the area of the image exhibiting the highest 25% of signal intensity. Data were assessed using the analysis of variance and Student’s t-tests. Results: The measured diameter of the anterior wall of the gallbladder significantly varied based upon gel analog (P = 0.008). Wherein, Aquasonic USG (x̅ = 0.45 cm, σ = 0.17 cm) outperformed isopropyl alcohol (x̅ = 0.29 cm, σ = 0.05 cm) (P = 0.010). No significant differences in the reliability of anatomical measurements were detected between the remaining gel analogs. The quality of image as defined by the field of view consists of the upper 25% signal intensity varied by diagnostician. Wherein the area of detectable signal was greater in the gallbladder view (30.9% vs. 24.2%; P = 0.004) and left upper quadrant (36.9% vs. 26.0%; P < 0.001), when produced by a fellowship trained diagnostician. Conclusion: There is no significant difference in the quality of image produced between USG media and many common household alternatives. Irrespective of the media used, fellowship trained diagnosticians regularly produces the scans of higher quality than an individual lacking dedicated training. The use of image analysis software for determining the diagnostic accuracy of novel ultrasound technologies should be further explored. Keywords: Image quality, low-cost ultrasound, ultrasound, ultrasound gel, ultrasound images Age and High-sensitivity Troponin Algorithm for Evaluating Possible Myocardial Infarction Brandon R. Allen, Richard M. Nowak1, James C. O’Neill2, Nicklaus P. Ashburn2, Anna C. Snavely2, Brennan E. Paradee2, Robert H. Christenson3, Bryn E. Mumma4, Troy Madsen5, Jason P. Stopyra2, Simon A. Mahler2 University of Florida, Gainesville, FL, 1Henry Ford Health System, Detroit, MI, 2Wake Forest University, Winston-Salem, NC, 3University of Maryland, Baltimore, MD, 4University of California, Davis, California, 5University of Utah, Salt Lake, Utah, USA Background: The European Society of Cardiology (ESC) 0/1-hour high-sensitivity troponin (hs-cTn) algorithm is used for evaluating patients presenting to the emergency department (ED) with symptoms suspicious for non-ST-segment elevation myocardial infarction (NSTEMI). The objective of this secondary analysis of the STOP-CP (High-sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) United States (US) multicenter study was to evaluate the safety and efficacy of the ESC 0/1-hour hs-cTnT algorithm by age. Methods: Patients (≥21 years old) presenting to the ED with symptoms suggestive of NSTEMI were enrolled at 8 US EDs. The ESC hs-cTnT 0/1-hour algorithm was used to place patients into rule-out, observe, and rule-in NSTEMI zones. Algorithm performance for rapid NSTEMI rule-out and 30-day adverse outcomes was studied in three age (years) intervals: younger (21–45), middle aged (46–64), and older (≥65). Major adverse cardiovascular events (MACEs) consisted of a cardiac death, myocardial infarction, or coronary revascularization at 30 days. Fisher’s exact tests were used to compare NSTEMI ruled out and MACE rates between patient age intervals. Negative likelihood ratios (NLR) with a 95% confidence interval (CI) were calculated for 30-day MACE. Results: Overall, 1430 participants were enrolled with 15.7% (224/1430) young, 57.4% (821/1430) middle-aged, and 26.9% (385/1430) being older. The ESC 0/1 h-cTnT 0/-hour algorithm NSTEMI ruled out rates were 79.9% (179/224), 62.1% (510/821), and 35.6% (137/385) for these age groupings (P < 0.0001). The overall 30-day MACE rate was 14.2% (203/1430) with interval age rates of 16/224 (7.1%) younger, 108/821 (13.1%) middle aged, and 79/385 (20.5%) older patients. Among NSTEMI ruled-out patients, MACE occurred in 1.1% (2/179) of younger, 3.3% (17/510) middle aged, and 2.9% (4/137) of older individuals.(P = 0.320). NLR for 30-day MACE was 0.15 (95% CI: 0.04–0.54) in younger, 0.23 (95% CI: 0.15–0.35) middle aged, and 0.12 (95% CI: 0.04-0.31) older patients. Conclusion: With increasing age, patients were less likely to be rapidly ruled out for NSTEMI. Age interval alone was not an independent variable that added to the risk stratification of this patient group for 30-day MACE. Our report suggests that currently used cardiac risk stratification scores using age as a variable for 30-day MACE in rapidly ruled-out NSTEMI patients require reevaluation. Keywords: Age, chest pain, high-sensitivity troponin, major adverse cardiovascular event, myocardial infarction, non-ST-segment elevation myocardial infarction, troponin Perceptions of an Aseptic Touch-free Disposable Stethoscope Barrier Lee Anne Siegmund, W. Frank Peacock1, James F. Bena2, Shannon L. Morrison2 Cleveland Clinic Nursing Research and Innovation, 2Cleveland Clinic Quantitative Health Science, Cleveland, Ohio, 1Baylor College of Medicine, Houston, TX, USA Background: Hand washing is an accepted practice for preventing hospital-acquired infections; however, stethoscope hygiene is rarely performed despite that stethoscopes carry a similar bacterial load compared to hands. When cleaned for 60 s (Centers for Disease Control and Prevention recommended) with alcohol, stethoscopes sometimes remain contaminated with pathogens, while touch-free barriers were shown to provide bacteriologically impervious surfaces. The purpose of this study is to determine patients’ and nurses/providers’ perceptions of ease of use, compliance, and patient safety when comparing touch-free stethoscope diaphragm barriers, alcohol, or no cleaning. Methods: Patients and nurses/providers viewed videos comparing three stethoscope hygiene techniques (touch-free barrier, alcohol for 60 s, or no cleaning) followed by a survey. Pairwise comparisons and Bonferroni correction were calculated. Wilcoxon rank tests assessed if responses differed from the midpoint. Alpha was 0.05. Results: Patients (n = 119) witnessed providers cleaning their stethoscope “sometimes” or “not sure” and when asked their opinion of cleaning or barriers, barriers were rated as equal or superior to alcohol. Nurses/providers (n = 121) said that they cleaned between patients “most” or “always,” were more likely to choose “significantly or slightly improve” compliance over “significantly or slightly worsen” stethoscope hygiene compliance (P < 0.001). Both groups responded stethoscope hygiene was important, barriers would be easiest to use or positively impact workflow (P < 0.001), and alcohol was superior to touch-free barrier for patient safety (P < 0.001). Conclusion: Participants perceived alcohol as superior to touch-free barriers for patient safety, which contradicts prior data that touch-free barriers were 100

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