.jpg "Yash Patel photo")
Yash Patel
Wake Forest Baptist Health
Winston Salem, North Carolina
Disclosure information not submitted.
John Levi
Medical Student
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Patrick A. Brown, MD
Assistant Professor, Neuroradiology
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Andrew Asimos, MD
Professor, Emergency Medicine
Carolina's Medical Center, United States
Disclosure information not submitted.
Stacey Wolfe, MD
Associate Professor, Neurosurgery
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Joshua Zavitz, DO
Assistant Professor, Emergency Medicine
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Casey Glass, MD
Associate Professor, Emergency Medicine
Wake Forest School of Medicine, United States
Disclosure information not submitted.
Aarti Sarwal, MD, FAAN, FNCS,FCCM
Medical Director, Neurocritical Care
Wake Forest Baptist Health Center
Winston-Salem, North Carolina
Disclosure information not submitted.
Title: Pilot Study to Asses Factors that Affect Accuracy of B-Mode Cranial POCUS for ICH Diagnosis
Introduction: Time based therapies for Intracranial Hemorrhage (ICH) are challenging to implement due to the lack of early field diagnosis that can inform management. Point of Care Ultrasound (POCUS) has several clinical applications but has not been explored for ICH. We performed an exploratory study to assess factors that affect the accuracy of cranial POCUS B mode for diagnosis of ICH. This study will inform larger clinical trial to help test accuracy of cPOCUS compared to a CT scan for early diagnosis of ICH.
Methods: After obtaining IRB approval and ensuring temporal windows, we enrolled 11 patients in a tertiary care neurocritical care unit over 9 months beginning August 2020. Cranial Ultrasound B mode images were acquired on consented patients using ICU POCUS machine using transcranial presets. One investigator blinded to pathology performed the ultrasounds and reported the diagnosis immediately after the scan. All acquired images were reviewed post-hoc by a blinded neuroradiologist and then compared to CT scans for elucidating B-mode pathology.
Results: 12 consented patients yielded 11 scans. Patients had a mean age of 58.3 years ±16.1 years (28-88 yrs; 3 males). The sensitivity and specificity of point of care diagnosis of ICH was 100% and 40% respectively. These numbers were significantly lower for post-hoc diagnosis. Comparing ultrasound images with CT scan/MRI, false positive ICH diagnosis was attributed to intracranial tumors and choroid calcifications.
Conclusion: Our exploratory analysis yielded preliminary data on use of cranial ultrasound for ICH diagnosis. This pilot study is limited by small numbers, lack of available training and image library of cranial ultrasound pathology. A current ongoing trial is exploring the accuracy of cranial ultrasound compared to CT scan for possible field diagnosis of ICH.