We have excellent research infrastructure at both sites, with access to research assistants, biostatisticians, and some of the best minds in emergency medicine research. Also, UCLA has a NIH-funded clinical translational science institute (CTSI) that offers access to further research and methodological support. 

Our ultrasound group believes in team-based, multidisciplinary research. We include medical students and residents on our research projects. Currently we have active projects in the following areas:

Fluid Responsiveness

We are comparing sonographic measures of fluid (or volume) responsiveness with criterion standards such as fluid bolus and non-invasive cardiac output monitors. This is novel ED-based research, and important, since studies have demonstrated that early fluid resuscitation improves outcomes, whereas fluid therapy 6-72 hours after arrival is associated with increased mortality. We completed a study on healthy volunteers which was presented at the national SAEM conference in 2014. We received funding to conduct a similar study on patients presenting with severe sepsis or septic shock. We recently completed a pilot study on critically ill patients in the ICU that was funded by an EMF grant in 2016.

Effect of Sonographic Criteria of Biliary Disease and Patient Outcomes

Biliary ultrasonography provides a snapshot during the progression of biliary colic, in which findings such as a positive sonographic Murphy, wall thickening, and/or pericholecystic fluid, may resolve hours after initial onset. While many know of the risk factors for cholelithiasis (the “4F’s”), these are not the same risk factors for gangrenous cholecystitis, perforation, and sepsis. We seek to find patient, lab, and sonographic risk factors that are associated with poor outcomes, as well as a risk prediction tool that can identify low-risk patients who can benefit from outpatient management and elective cholecystectomy. Our study of over 250 patients has been accepted to the ACEP Annual Assembly 2016 for presentation.

Acute Heart Failure

Acute heart failure (AHF) accounts for over one million hospitalizations per year, with a 30-day readmission rate of 25%, costing roughly $25 billion annually. A major issue is not being able to diagnose the type and severity of AHF, and therefore not being able to reliably identify patients that can be safely treated and discharged from the ED. We received UCLA CTSI funding to evaluate the ability of emergency physicians to perform a focused heart failure ultrasound that can identify type, severity, and response to treatment. 

Our research was featured on the Skeptics’ Guide to Emergency Medicine here.

Ultrasound in Undergraduate Medical Education

We are integrating ultrasound education into all four years of the UCLA medical school curriculum. With this comes multiple ways to assess innovative methods and technologies, including the use of peer instruction, simulation, FOAM, and other adjunct methods like QStream's spaced education concept and UCLA-developed perceptual adaptive learning modules (PALMs).

Ocular Ultrasound in Retinal and Vitreous Detachment

We are evaluating the relative influence of the static exam, kinetic exam, identification of the optic nerve sheath insertion, and over gaining, on emergency physician ability to diagnose and differentiate retinal vs. vitreous detachment. We are collaborating with UC Irvine, University of Southern California, and Loma Linda on this multi-center trial. We produced a short video on the study.

YouTube Video

Pelvic Ultrasonography and ED Length of Stay

In addition to biliary colic and retinal/vitreous detachment, Olive View-UCLA sees a high volume of patients with pelvic pathology. This presents an excellent opportunity to assess the effect of ED physician training in ultrasonography on accuracy and outcomes, in both pregnant and non-pregnant patients.