[Point of Care Ultrasound in Primary Care. Is it a high resolution tool?]

[Use of clinical ultrasound in primary care: Multicenter prospective study]

OBJECTIVE

The objective was to describe the characteristics of the use of clinical ultrasound in two health centers (SC) of Health Area VII of the Region of Murcia (CS Murcia-Sur and CS Floridablanca).

DESIGN

Observational, descriptive, longitudinal, prospective and multicenter study. SITE: CS Murcia-Sur and CS Floridablanca (Health Area VII of the Region of Murcia).

PARTICIPANTS

One hundred and thirty-five patients were included.

INTERVENTIONS

Performance of clinical ultrasound in the primary care (PC) consultation.

MAIN MEASUREMENTS

Demographic variables (age, sex), as well as clinical variables (reason for consultation, type of ultrasound, results, referrals to the second hospital level, degree of diagnostic agreement) were collected.

RESULTS

One hundred and thirty-five patients were included, more than 50% were female. The main reason for consultation was musculoskeletal and soft tissue symptoms (44.4%), followed by digestive symptoms (21.5%). 44.4% of the ultrasounds were classified as normal, while pathological findings were found in 55.6%. Confirmatory tests were requested in 43.7% and the findings were confirmed in 67% of the patients.

CONCLUSIONS

The use of ultrasound in PC allows to show the high prevalence of pathological findings in the examination of patients. In a technique that helps the clinician in his diagnostic-therapeutic process. The integration of clinical ultrasound in the PC consultation can save complementary studies and referrals to a second level of care. Its implementation in PC requires proper training of professionals.

Point-of-care ultrasound: An emerging clinical tool to enhance physical assessment

ABSTRACT

Point-of-care ultrasound (PoCUS) is a cost-effective diagnostic technology that, with training, is accessible, portable, and a convenient diagnostic modality to complement physical assessments. PoCUS is beneficial in that it can reduce the number of imaging tests required, while also mitigating barriers to healthcare for rural and remote communities.

Hospitalization Trends for Acute Appendicitis in Spain, 1998 to 2017

The incidence of acute appendicitis decreased in Western countries from 1930 to at least the early 1990s, when epidemiological data started becoming scarcer. This study aimed to assess the trend in annual hospitalizations for acute appendicitis in all people Spain for a 20-year period between 1998 and 2017. This observational study analyzing direct age-standardized hospital admission rates by gender and age group (0–14 years, 15–34 years, 35–44 years, 45–64 years, and ≥65 years). Joinpoint regression models were fitted to evaluate changes in trends. There were 789,533 emergency hospital admissions for acute appendicitis between 1998 and 2017: 58.9% in boys and men and 41.1% in girls and women. Overall, there was a significant increase in admissions for this cause from 1998 to 2009, with an annual percent change (APC) of 0.6%. Following the peak in 2009, admission rates decreased by around 1.0% annually until 2017. The length of hospital stay gradually decreased from 4.5 days in 1998 to 3.4 days in 2017. The trends in hospital admissions for acute appendicitis in Spain changed over the study period, decreasing from 2009, especially in people younger than 35 years.

Usefulness of Lung Ultrasound Examinations Performed by Primary Care Physicians in Patients With Suspected COVID-19

OBJECTIVES

In patients with suspected coronavirus disease 2019 (COVID-19) consulting primary care (PC) centers, clinical criteria may not be sensitive enough to detect many cases in which complications first occur. We intended to assess whether lung ultrasound (LUS) examinations performed by PC physicians are a useful tool to detect lung injury and may help in decisions about hospital referral.

METHODS

This study included 61 patients with moderate symptoms suggesting COVID-19 who were evaluated with LUS by PC physicians and then referred to a hospital during the current pandemic peak in Madrid. We analyzed association of a simple self-designed LUS severity scale (grade 0, normal; grade 1, multiple separated B-lines, pleural irregularity, or both; and grade 2, coalescent B-lines, consolidations, pleural effusion, or a combination thereof) with the main outcome indicating adequacy of hospital referral, and also with chest x-ray (CXR) findings.

RESULTS

The proposed LUS severity scale was significantly associated with the main outcome of appropriate referral (P = 0.001): the higher the scale, the higher the percentage of adequate referrals. The LUS scale was also associated with a CXR severity scale (P = 0.034). The presence of coalescent B-lines was the only independent LUS finding significantly associated with the appropriate-referral outcome (P =0 .008) and also with a higher probability of hospital admission (P = 0.02) and with several CXR findings.

CONCLUSIONS

This study supports the use of LUS in PC as a tool to assess patients with suspected COVID-19. Its use can reduce uncertainty during clinical evaluations of moderate patients, facilitate early detection of lung involvement, allow early appropriate referral, and avoid unnecessary referral.

Environmental and Patient Impact of Applying a Point-of-Care Ultrasound Model in Primary Care: Rural vs. Urban Centres

Motor vehicles are a major contributor to air pollution, and the exposure to this human-caused air pollution can lead to harmful health effects. This study evaluates the impact of the provision of point-of-care ultrasounds (POCUS) by primary care (PC) to avoid the patient's need to travel to a specialized service. The study estimates the costs and air pollution avoided during 2019. The results confirm that performing this ultrasound at the point of care reduces the emission of 61.4 gr of carbon monoxide, 14.8 gr of nitric oxide and 2.7 gr of sulfur dioxide on each trip. During the study, an average of 17.8 km, 21.4 min per trip and almost 2000 L of fuel consumed in a year were avoided. Performing POCUS from PC reduces fuel consumption and the emission of air pollutants and also saves time and money. Furthermore, only 0.3% of the scans had to be repeated by radiologists. However, more studies with more participants need to be done to calculate the exact impact that these pollution reductions will have on human health.

[Point-of-care ultrasound: Is it time to include it in the paediatric specialist training program?]

Point-of-care ultrasound (POCUS) has become an essential tool for clinical practice in recent years. It should be considered as an extension of the standard physical examination, which complements and enriches it without substituting it. POCUS enables the physician to answer specific clinical questions about the diagnosis, to understand better the pathophysiological context, to orientate the treatment, and to perform invasive procedures more safely. Despite its current use in many centres, and in most paediatric sub-specialties, there are currently no specific recommendations addressing educational aims in the different training areas, as well as methodology practice and the certification process in paediatrics. These ingredients are essential for POCUS implementation in daily practice, with a quality guarantee in terms of efficiency and safety. Several POCUS experts in different paediatric medicine environments performed a non-systematic review addressing the main paediatric POCUS applications in paediatrics. The lack of educational programs in POCUS in Spain is also discussed, and the experience in the United States of America in this topic is provided. Considering the current situation of POCUS in paediatrics, we strongly believe that it is urgent to establish evidence-based recommendations for POCUS training that should be the base to develop educational programs and to include POCUS in the paediatric residency training.