Drowning rule‐out with novices (DROWN) in ultrasound
Abstract Objectives Non‐fatal drownings confer significant morbidity and mortality in the United States. Chest radiograph (CXR) is typically used as a screening modality for interstitial edema but lacks sensitivity early after submersion. No study has evaluated lung ultrasound in assessing for pulmo...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.13010 |
| _version_ | 1827860579110354944 |
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| author | Stewart Russ Richardson Jacob Pope Leslie B. Hart Casey L. Wilson |
| author_facet | Stewart Russ Richardson Jacob Pope Leslie B. Hart Casey L. Wilson |
| author_sort | Stewart Russ Richardson |
| collection | DOAJ |
| description | Abstract Objectives Non‐fatal drownings confer significant morbidity and mortality in the United States. Chest radiograph (CXR) is typically used as a screening modality for interstitial edema but lacks sensitivity early after submersion. No study has evaluated lung ultrasound in assessing for pulmonary edema after submersion events and we hypothesized that lung point‐of‐care (POC) ultrasound can identify interstitial edema in patients presenting after non‐fatal drownings. Methods Patients presenting to the emergency department after a submersion event were eligible if a CXR was obtained as part of their care. Emergency medicine residents performed a lung POC ultrasound and provided a “novice” interpretation of “normal” or “abnormal,” which was independently reviewed by a blinded expert sonographer. Patients were contacted 2 weeks after presentation to assess for late sequela. Results A prospective convenience sample of 59 patients included 21 adults (36%) and 38 children (64%) enrolled over 17 months with a median age of 6. Twenty‐four (41%) patients had abnormalities on CXR. Of these, 20 patients had a positive ultrasound per novice interpretation. Compared to CXR, ultrasound had an overall sensitivity of 83% and a specificity of 66% for detecting pulmonary edema in non‐fatal drownings. Notably, out of 35 subjects with a negative CXR, there were 12 (34%) cases with a positive lung ultrasound, 10 of which required hospital admission. Conclusion Lung POC ultrasound has a moderate sensitivity and specificity when performed by novice sonographers to detect pulmonary edema presenting to an ED setting after a non‐fatal drowning event. |
| first_indexed | 2024-03-12T13:26:12Z |
| format | Article |
| id | doaj.art-29116af4a26442ed9b804211609a1aef |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-03-12T13:26:12Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-29116af4a26442ed9b804211609a1aef2023-08-25T05:44:30ZengWileyJournal of the American College of Emergency Physicians Open2688-11522023-08-0144n/an/a10.1002/emp2.13010Drowning rule‐out with novices (DROWN) in ultrasoundStewart Russ Richardson0Jacob Pope1Leslie B. Hart2Casey L. Wilson3Department of Emergency Medicine Grand Strand Medical Center Myrtle BeachSouth CarolinaUSADepartment of Emergency Medicine Grand Strand Medical Center Myrtle BeachSouth CarolinaUSAIndependent contractor CharlestonSouth CarolinaUSADepartment of Emergency Medicine Grand Strand Medical Center Myrtle BeachSouth CarolinaUSAAbstract Objectives Non‐fatal drownings confer significant morbidity and mortality in the United States. Chest radiograph (CXR) is typically used as a screening modality for interstitial edema but lacks sensitivity early after submersion. No study has evaluated lung ultrasound in assessing for pulmonary edema after submersion events and we hypothesized that lung point‐of‐care (POC) ultrasound can identify interstitial edema in patients presenting after non‐fatal drownings. Methods Patients presenting to the emergency department after a submersion event were eligible if a CXR was obtained as part of their care. Emergency medicine residents performed a lung POC ultrasound and provided a “novice” interpretation of “normal” or “abnormal,” which was independently reviewed by a blinded expert sonographer. Patients were contacted 2 weeks after presentation to assess for late sequela. Results A prospective convenience sample of 59 patients included 21 adults (36%) and 38 children (64%) enrolled over 17 months with a median age of 6. Twenty‐four (41%) patients had abnormalities on CXR. Of these, 20 patients had a positive ultrasound per novice interpretation. Compared to CXR, ultrasound had an overall sensitivity of 83% and a specificity of 66% for detecting pulmonary edema in non‐fatal drownings. Notably, out of 35 subjects with a negative CXR, there were 12 (34%) cases with a positive lung ultrasound, 10 of which required hospital admission. Conclusion Lung POC ultrasound has a moderate sensitivity and specificity when performed by novice sonographers to detect pulmonary edema presenting to an ED setting after a non‐fatal drowning event.https://doi.org/10.1002/emp2.13010emergency medicinenear drowningpoint‐of‐careultrasound |
| spellingShingle | Stewart Russ Richardson Jacob Pope Leslie B. Hart Casey L. Wilson Drowning rule‐out with novices (DROWN) in ultrasound Journal of the American College of Emergency Physicians Open emergency medicine near drowning point‐of‐care ultrasound |
| title | Drowning rule‐out with novices (DROWN) in ultrasound |
| title_full | Drowning rule‐out with novices (DROWN) in ultrasound |
| title_fullStr | Drowning rule‐out with novices (DROWN) in ultrasound |
| title_full_unstemmed | Drowning rule‐out with novices (DROWN) in ultrasound |
| title_short | Drowning rule‐out with novices (DROWN) in ultrasound |
| title_sort | drowning rule out with novices drown in ultrasound |
| topic | emergency medicine near drowning point‐of‐care ultrasound |
| url | https://doi.org/10.1002/emp2.13010 |
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