Mount Cristin, Taylor David, Skinner Carl, Grogan Scott
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA 98431, USA.
Mil Med. 2023 May 16;188(5-6):e949-e952. doi: 10.1093/milmed/usab422.
Point-of-care ultrasound (POCUS) is a tool undergoing expanding use in military medicine, including routine inpatient, outpatient, and operational environments. Specific musculoskeletal POCUS examinations require additional equipment in the form of a standoff assist device to maximize image acquisition. These devices may not be readily available to POCUS users in more austere or resource-constrained environments. We devised a study to determine if intravenous fluid bags of various volumes could be substituted for standard standoff devices in musculoskeletal POCUS.
Sequential images of a soft tissue foreign body model, an interphalangeal joint, and a chest wall were taken using a gel standoff pad or water bath and compared to images acquired using three different sizes of intravenous fluid bags after removing excess air from the bags. Images were de-identified and scored for quality using a visual analog scale. We used a two-factor analysis of variance without replication to analyze the differences in image quality between standoff devices, with a P-value less than.05 considered statistically significant.
We performed 13 POCUS studies and had a group of eight POCUS-trained physicians and physician assistants score these studies, resulting in 104 total quality scores. There was no significant difference in image quality between standoff devices for chest (P-value.280) and hand (P-value 0.947) images. We found a significant difference in image quality between standoff devices for the soft tissue foreign body model (P-value 0.039), favoring larger intravenous fluid bag standoff over standard devices.
In the absence of a standard commercial gel standoff device or water bath, intravenous fluid bags of 50, 100, and 250 mL can facilitate quality image acquisition for musculoskeletal POCUS.
即时超声检查（POCUS）是一种在军事医学中使用日益广泛的工具，包括在常规住院、门诊及作战环境中。特定的肌肉骨骼POCUS检查需要额外的设备，即支撑辅助装置，以优化图像采集。在更为艰苦或资源受限的环境中，POCUS使用者可能无法轻易获得这些设备。我们开展了一项研究，以确定不同容量的静脉输液袋能否替代肌肉骨骼POCUS中的标准支撑装置。
使用凝胶支撑垫或水浴对软组织异物模型、指间关节和胸壁进行连续成像，并与从静脉输液袋中排出多余空气后使用三种不同尺寸静脉输液袋获取的图像进行比较。对图像进行去识别处理，并使用视觉模拟量表对图像质量进行评分。我们使用无重复双因素方差分析来分析支撑装置之间图像质量的差异，P值小于0.05被认为具有统计学意义。
我们进行了13项POCUS研究，并让一组8名经过POCUS培训的医生和医师助理对这些研究进行评分，共得到104个质量评分。胸部（P值0.280）和手部（P值0.947）图像的支撑装置之间图像质量无显著差异。我们发现软组织异物模型的支撑装置之间图像质量存在显著差异（P值0.039），较大的静脉输液袋支撑优于标准装置。
在没有标准商用凝胶支撑装置或水浴的情况下，50、100和250毫升的静脉输液袋可为肌肉骨骼POCUS获取高质量图像提供便利。
