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Objectives Point-of-care ultrasound (POCUS) may facilitate the diagnosis and management of children for various conditions. Integration of POCUS into clinical care requires hands-on training; however, providers may be reluctant to perform educational ultrasounds to improve their skills, as it is a procedure without direct clinical benefit to the patient and due to concerns that it may lower a family's overall satisfaction. We sought to evaluate whether the use of POCUS changed overall patient/caregiver satisfaction in a pediatric emergency department (ED) visit. Methods We performed a prospective cohort study of children presenting to a single children's hospital ED. We evaluated overall satisfaction for three groups: 1) children undergoing POCUS for educational purposes, 2) children undergoing POCUS for a specific diagnostic indication, and 3) controls who did not receive POCUS. Overall satisfaction was measured using a 100-point visual analog scale (VAS). We performed a noninferiority test between patients receiving POCUS and controls using a delta of 10 points to determine significance. We also examined satisfaction among patients receiving diagnostic ultrasound and sought to determine patient/caregiver satisfaction with specific elements of the POCUS experience. Results We surveyed 159 patients who presented between April 2016 and August 2016 (53 in each group). The three groups did not differ with respect to patient age, sex, or Emergency Severity Index level. The median VAS scores for both the educational and the diagnostic POCUS groups (94 and 94, respectively) were not inferior to the VAS score for the control group (91) with a median (95% confidence interval [CI]) difference of 3.0 (-2.2 to 8.2) for educational and control groups and 3.0 (-1.6 to 7.6) for diagnostic and control groups. No patients/caregivers in the educational POCUS group would refuse an educational ultrasound during a future medical encounter. Conclusion Educational POCUS does not decrease patient/caregiver satisfaction among children presenting to the ED.

Objectives The objective was to evaluate the diagnostic accuracy of five health literacy screening instruments in emergency department (ED) patients: the Rapid Evaluation of Adult Literacy in Medicine-Revised (REALM-R), the Newest Vital Sign (NVS), Single Item Literacy Screens (SILS), health numeracy, and physician gestalt. A secondary objective was to evaluate the feasibility of these instruments as measured by administration time, time on task, and interruptions during test administration. Methods This was a prospective observational cross-sectional study of a convenience sampling of adult patients presenting during March 2011 and February 2012 to one urban university-affiliated ED. Subjects were consenting non–critically ill, English-speaking patients over the age of 18 years without aphasia, dementia, mental retardation, or inability to communicate. The diagnostic test characteristics of the REALM-R, NVS, SILS, health numeracy, and physician gestalt were quantitatively assessed by using the short Test of Functional Health Literacy in Adults (S-TOFHLA). A score of 22 or less was the criterion standard for limited health literacy (LHL). Results A total of 435 participants were enrolled, with a mean (±SD) age of 45 (±15.7) years, and 18% had less than a high school education. As defined by an S-TOFHLA score of 22 or less, the prevalence of LHL was 23.9%. In contrast, the NVS, REALM-R, and physician gestalt identified 64.8, 48.5, and 35% of participants as LHL, respectively. A normal NVS screen was the most useful test to exclude LHL, with a negative likelihood ratio of 0.04 (95% confidence interval [CI] = 0.01 to 0.17). When abnormal, none of the screening instruments, including physician gestalt, significantly increased the posttest probability of LHL. The NVS and REALM-R require 3 and 5 minutes less time to administer than the S-TOFHLA. Administration of the REALM-R is associated with fewer test interruptions. Conclusions One-quarter of these ED patients had marginal or inadequate health literacy. Among the brief screening instruments evaluated, a normal NVS result accurately reduced the probability of LHL, although it will identify two-thirds of ED patients as high risk for LHL. None of the brief screening instruments significantly increases the probability of LHL when abnormal. Resumen Objetivos Evaluar la certeza diagnostica de cinco instrumentos de despistaje de educacion sanitaria en los pacientes del servicio de urgencias (SU): el Rapid Evaluation of Adult Literacy in Medicine-Revised (REALM-R), el Newest Vital Sign (NVS), el Single Item Literacy Screens (SILS), los calculos numericos relacionados con la salud y un medico gestaltico. Un objetivo secundario fue evaluar la viabilidad de estos instrumentos medida por el tiempo de administracion, el tiempo en la tarea y las interrupciones durante la administracion del test. Metodologia Estudio transversal de una muestra de conveniencia de pacientes adultos que acudieron durante marzo de 2011 y febrero de 2012 a un SU universitario y urbano. Los sujetos que consintieron fueron enfermos no criticos, de habla inglesa y mayores de 18 anos de edad sin afasia, demencia, retraso mental o incapacidad para comunicarse. Las caracteristicas de los tests diagnosticos REALM-R, NVS, SILS y calculo numerico relativo a la salud y del medico gestaltico se evaluaron cuantitativamente mediante la forma abreviada del Test of Functional Health Literacy in Adults (S-TOFHLA). Una puntuacion de 22 o menos fue el criterio estandar para considerar una educacion sanitaria limitada (ESL). Resultados Se incluyeron 435 participantes, con una media de edad de 45 anos (DE), y un 18% tenia una formacion inferior a la escuela secundaria. Como se definio por una puntuacion de S-TOFHLA de 22 o menos, la prevalencia de ESL fue un 23,9%. En comparacion, el NVS, el REALM-R, y el medico gestaltico identificaron un 64,8%, un 48,5%, y un 35% de los participantes como ESL, respectivamente. Un NVS normal fue el test mas util para excluir ESL, con una razon de probabilidad negativa de 0,04 (IC 95% = 0,01 a 0,17). Cuando fue anormal, ninguno de los instrumentos de despistaje, incluyendo el medico gestaltico, incremento significativamente la probabilidad post-test de ESL. El NVS y el REALM-R requieren 3 y 5 minutos menos de tiempo para administrase que el S-TOFHLA. La administracion del REALM-R se asocia con menos interrupciones del test. Conclusiones Una cuarta parte de los pacientes del SU tiene una educacion sanitaria inadecuada o marginal. Entre los instrumentos de despistaje breves evaluados, un resultado normal en el NVS redujo certeramente la probabilidad de una ESL, aunque identificara dos tercios de los pacientes del SU como de alto riesgo para una ESL. Ninguno de los instrumentos breves de despistaje incrementa significativamente la probabilidad de ESL cuando es anormal.