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De Carvalho H, Godiveaux N, Javaudin F, Le Bastard Q, Kuczer V, Pes P, Montassier E, Le Conte P. Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound: Survey on 515 Physicians. Ultrasound Q 2024; 40:46-50. [PMID: 37756253 DOI: 10.1097/ruq.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT Point-of-care ultrasound (POCUS) curriculum varies among countries. However, the length of training required for physicians is still under debate. We investigated the impact of different training methods: short hands-on courses (STS), long academic training sessions (LTS), or both (mixed training [MTS]), for POCUS daily use and self-reported confidence overall and specific to specific clinical situations. This was a descriptive study conducted over a 3-month period through a Web-based survey designed to assess the influence of different methods of POCUS training among physicians and residents on their daily practice. The survey was sent to 1212 emergency physicians with prior POCUS training; 515 answers (42%) could be analyzed. Participants in the STS group performed POCUS less frequently than physicians in the LTS or MTS group. Daily use in the STS group was 51% versus 82% in the LTS group and 83% in the MTS group ( P < 0.01). The overall self-reported confidence in POCUS was lower in the STS group ( P < 0.01) in all studied clinical situations. There was no significant difference between LTS and MTS groups ( P > 0.05). Method of POCUS training significantly influenced POCUS daily use. Physicians who underwent long training sessions used POCUS more frequently in their routine practice and were significantly more confident in their ability to perform and interpret a POCUS examination.
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Affiliation(s)
| | | | | | | | | | - Philippe Pes
- Emergency Department, Centre Hospitalier Universitaire
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Gaudreau-Simard M, Saiyin T, Mcinnes MDF, Ruller S, Clark EG, Wooller K, Kilabuk E, Forster AJ, Woo MY. Test characteristics of point-of-care ultrasonography in patients with acute kidney injury. Ultrasound J 2024; 16:15. [PMID: 38388747 PMCID: PMC10884383 DOI: 10.1186/s13089-023-00352-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Acute kidney injury is a common disorder that is associated with significant morbidity and mortality. Point-of-care ultrasonography (PoCUS) is an imaging modality performed at the bedside and is used to assess for obstructive causes of acute kidney injury. Little is known about the test characteristics of PoCUS in patients with acute kidney injury. OBJECTIVE Our primary objective was to describe the test characteristics of PoCUS for the detection of hydronephrosis in patients presenting with acute kidney injury at our centre. Our secondary objective was to describe the current rate of use of PoCUS for this indication. RESULTS In total, 7873 patients were identified between June 1, 2019 and April 30, 2021, with 4611 meeting inclusion criteria. Of these, 94 patients (2%) underwent PoCUS, and 65 patients underwent both PoCUS and reference standard, for a total of 124 kidneys included in our diagnostic accuracy analysis. The prevalence of hydronephrosis in our cohort was 33% (95% CI 25-41%). PoCUS had a sensitivity of 85% (95% CI 71-94%) and specificity of 78% (95% CI 68-87%) for the detection of hydronephrosis. CONCLUSION We describe the test characteristics of PoCUS for the detection of hydronephrosis in a cohort of patients with acute kidney injury. The low uptake of this test presents an opportunity for quality improvement work to increase its use for this indication.
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Affiliation(s)
- Mathilde Gaudreau-Simard
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Tana Saiyin
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Matthew D F Mcinnes
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Diagnostic Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Sydney Ruller
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Edward G Clark
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Krista Wooller
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Elaine Kilabuk
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alan J Forster
- Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Y Woo
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
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Popat A, Harikrishnan S, Seby N, Sen U, Patel SK, Mittal L, Patel M, Vundi C, Patel Y, Babita, Kumar A, Nakrani AA, Patel M, Yadav S. Utilization of Point-of-Care Ultrasound as an Imaging Modality in the Emergency Department: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52371. [PMID: 38694948 PMCID: PMC11062642 DOI: 10.7759/cureus.52371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 05/04/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
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Affiliation(s)
- Apurva Popat
- Internal Medicine, Marshfield Clinic Health System, Marshfield, USA
| | | | - Niran Seby
- Internal Medicine, Tbilisi State Medical University, Tbilisi, GEO
| | - Udvas Sen
- Internal Medicine, Agartala Government Medical College, Agartala, IND
| | - Sagar K Patel
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Bhuj, IND
| | - Lakshay Mittal
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Mitkumar Patel
- Internal Medicine, Mahatma Gandhi Mission (MGM) Medical College, Navi Mumbai, IND
| | - Charitha Vundi
- Internal Medicine, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, IND
| | - Yashasvi Patel
- Internal Medicine, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Babita
- Internal Medicine, Uzhhorod National University, Uzhhorod, UKR
| | - Ashish Kumar
- General Practice, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Akash A Nakrani
- Internal Medicine, Gujarat Adani Institute of Medical Sciences, Surat, IND
| | - Mahir Patel
- Medical School, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Sweta Yadav
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
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Overgaard J, Thilagar BP, Bhuiyan MN. A Clinician's Guide to the Implementation of Point-of-Care Ultrasound (POCUS) in the Outpatient Practice. J Prim Care Community Health 2024; 15:21501319241255576. [PMID: 38773821 PMCID: PMC11113028 DOI: 10.1177/21501319241255576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 05/24/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a valuable clinical tool used at the patient bedside to rapidly assess a wide variety of symptoms and problems which would otherwise take hours or even days. Though it has become the standard of care in Emergency Medicine and is becoming so in hospital internal medicine, less uptake has been appreciated in the outpatient setting despite reported interest from clinicians practicing there. A number of common barriers have been cited to explain this gap in use, which usually include access to equipment, mentorship, and time. In this review we present a proposed framework for clinicians who have an interest in implementing POCUS in their outpatient practice which we hope can mitigate some of these barriers and provide a more streamlined pathway to their desired goals.
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Declerck C, Mahieu R, Sanderink D, de la Chapelle M, Abgueguen P, Vandamme YM, Dubée V. Implementation of point-of-care ultrasonography in an infectious disease ward. Infect Dis Now 2021; 52:87-92. [PMID: 34896661 DOI: 10.1016/j.idnow.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Point-of-care ultrasonography (POCUS) has emerged as an essential supplement to physical examination in many specialties. In contrast, its use by infectious diseases (ID) specialists remains anecdotal. Here, we report on the acquisition of an ultrasonography device in a French ID ward, and we describe its everyday use. METHODS A preliminary audit was conducted to evaluate the potential impact of the acquisition of an ultrasonography device. A second audit was performed during the first year following the acquisition of the device to quantify its everyday use. We also evaluated the impact of POCUS implementation on medical imaging requests by comparing the number of intra-hospital transports before and after the acquisition. RESULTS According to the first audit, 81 of the 199 (41%) imaging examinations that were prescribed during a two-month period could have been replaced by POCUS. During the first year following the acquisition of the ultrasonography device, POCUS was performed 240 times by 31 different operators. The operators were a senior physician, an intern, and a medical student in 94 (39%), 135 (57%), and 11 (5%) cases, respectively. The organs most frequently explored were the genito-urinary tract (n=74), the joints (n=35), and the lungs/pleura (n=35). Acquisition of the device was followed by a significant decrease in the number of transports to the ultrasonography room, whereas the total number of transports to the medical imaging ward did not change. CONCLUSION Opportunities to use POCUS in the ID ward are numerous. POCUS training should be part of the ID specialist's curriculum.
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Affiliation(s)
- C Declerck
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France.
| | - R Mahieu
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - D Sanderink
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - M de la Chapelle
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - P Abgueguen
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - Y M Vandamme
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
| | - V Dubée
- Infectious Disease and Tropical Medicine Ward, Angers University Hospital, Angers, France
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Nepal S, Dachsel M, Smallwood N. Point-of-care ultrasound rapidly and reliably diagnoses renal tract obstruction in patients admitted with acute kidney injury. Clin Med (Lond) 2021; 20:541-544. [PMID: 33199317 DOI: 10.7861/clinmed.2019-0417] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Point-of-care ultrasound (POCUS) is increasingly being used in the management of the acutely unwell patient. Its role in the breathless and shocked patient is well established, but less so for those patients with acute kidney injury (AKI). This local quality improvement project looked at the diagnostic accuracy of a protocolised POCUS versus departmental ultrasound. It provides the first data within the internal medicine setting to suggest that POCUS can rapidly and reliably diagnose renal tract obstruction, showing a sensitivity of 90% and a specificity of 100%. Additionally, negative predictive value was 99% suggesting it is a tool which can reduce the need for departmental ultrasound. More work is needed to see if this data is generalisable to other internal medicine settings, and to assess potential outcomes on patient management and length of stay.
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Hoytfox VA, Ward BC, Cox EJ, Zhang KX. POCUS Evaluation in Acute Kidney Injury. POCUS JOURNAL 2021; 6:67-69. [PMID: 36895675 PMCID: PMC9979922 DOI: 10.24908/pocus.v6i2.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute kidney injury is a common clinical problem encountered in general internal medicine. The evaluation of acute kidney injury is mainly driven by the patient's clinical history, physical exam, and laboratory investigation including urinalysis and urine sediment examination. Point of care ultrasound (POCUS) may be a useful tool to help clinicians to narrow and/or prioritize differential diagnosis in patients presenting with acute kidney injury. Here we present a case of a 67-year-old male presenting with dysuria, fevers, and flank pain along with elevation in serum creatinine who was admitted with concern for acute kidney injury secondary to complicated urinary tract infection. Subsequent kidney POCUS of the kidneys and bladder showed bilateral anechoic fluid collection within the kidney sinus with dilated calyces suggestive of bilateral hydronephrosis, most likely due to a new diagnosis of benign prostatic hyperplasia. This case demonstrates the use of POCUS-obtained valuable diagnostic information and subsequent therapeutic management for this patient presenting with suspected acute kidney injury.
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Affiliation(s)
- Vanessa A Hoytfox
- Providence Internal Medicine Residency Spokane, Providence Health Care Spokane, WA United States of America
| | - Brittney C Ward
- Providence Internal Medicine Residency Spokane, Providence Health Care Spokane, WA United States of America
| | - Emily J Cox
- Providence Medical Research Center, Providence Health Care Spokane, WA United States of America
| | - Kang X Zhang
- Providence Internal Medicine Residency Spokane, Providence Health Care Spokane, WA United States of America
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Torres-Macho J, Aro T, Bruckner I, Cogliati C, Gilja OH, Gurghean A, Karlafti E, Krsek M, Monhart Z, Müller-Marbach A, Neves J, Sabio R, Serra C, Smallwood N, Tana C, Uyaroğlu OA, Von Wowern F, Bosch FH. Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine. Eur J Intern Med 2020; 73:67-71. [PMID: 31836177 DOI: 10.1016/j.ejim.2019.11.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 02/07/2023]
Abstract
Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.
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Affiliation(s)
- J Torres-Macho
- Internal Medicine Department, Hospital Universitario Infanta Leonor, Complutense University, Spanish Society of Internal Medicine, Madrid, Spain.
| | - T Aro
- Department of Internal Medicine, Clinicum, Medical Faculty, University of Helsinki, Young Internists Subcommittee. European Federation of Internal Medicine. Finnish Society of Internal Medicine
| | - I Bruckner
- Romanian Society of Internal Medicine, Romania
| | - C Cogliati
- Internal Medicine Department. Ospedale Luigi Sacco, ASST-Fbf-Sacco. Italian Society of Internal Medicine, Milan, Italy
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - A Gurghean
- Internal Medicine Department. Cardiology, Coltea Clinical Hospital, University of Medicine and Pharmacy Bucharest, Romanian Society of Internal Medicine, Romania
| | - E Karlafti
- AHEPA University Hospital, Aristotle University of Thessaloniki, Internal Medicine Society of Greece, Greece
| | - M Krsek
- Third Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Czech Society of Internal Medicine, Prague
| | - Z Monhart
- Internal Medicine and Emergency Department, Hospital Znojmo, Czech Society of Internal Medicine, Czech Republic
| | - A Müller-Marbach
- Department of Gastroenterology, Hepatology und Palliative Care. Helios Hospital Niederberg, German Society of Internal Medicine, Velbert, Germany
| | - J Neves
- Serviço de Medicina Interna, Centro Hospitalar Universitário do Porto, Portuguese Society of Internal Medicine, Porto, Portugal
| | - R Sabio
- Hospital SAMIC de Alta Complejidad, Sociedad Argentina de Medicina (SAM), El Calafate, Argentina
| | - C Serra
- Diagnostic and Interventional Utrasound Unit. Division of Multiorgan Failure Emergency, General Surgery and Transplant Department. S.Orsola-Malpighi University Hospital. Italian Society of Internal Medicine
| | - N Smallwood
- Department of Acute Medicine, East Surrey Hospital. Society for Acute Medicine. United Kingdom
| | - C Tana
- Internal Medicine and Subacute Care Unit, University-Hospital of Parma, Federation of Associations of Hospital Doctors on Internal Medicine (FADOI), Parma, Italy
| | - O A Uyaroğlu
- Internal Medicine Department. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital. Turkish Society of Internal Medicine, Turkey
| | - F Von Wowern
- Department of Internal Medicine, University Hospitals of Skåne - Malmö, Swedish Society of Internal Medicine, Skane, Sweden
| | - F H Bosch
- Department of Internal Medicine, Radboud university medical center, Nijmegen and Rijnstate Hospital, Arnhem, the Netherlands
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Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019; 11:31. [PMID: 31749019 PMCID: PMC6868077 DOI: 10.1186/s13089-019-0145-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. METHODS Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. RESULTS On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. CONCLUSION Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.
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Affiliation(s)
- Bjarte Sorensen
- Hjelmeland General Practice Surgery, Prestagarden 13, 4130, Hjelmeland, Norway.
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
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Beaubien-Souligny W, Denault A, Robillard P, Desjardins G. The Role of Point-of-Care Ultrasound Monitoring in Cardiac Surgical Patients With Acute Kidney Injury. J Cardiothorac Vasc Anesth 2018; 33:2781-2796. [PMID: 30573306 DOI: 10.1053/j.jvca.2018.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Indexed: 12/15/2022]
Abstract
The approach to the patient with acute kidney injury (AKI) after cardiac surgery involves multiple aspects. These include the rapid recognition of reversible causes, the accurate identification of patients who will progress to severe stages of AKI, and the subsequent management of complications resulting from severe renal dysfunction. Unfortunately, the inherent limitations of physical examination and laboratory parameter results are often responsible for suboptimal clinical management. In this review article, the authors explore how point-of-care ultrasound, including renal and extrarenal ultrasound, can be used to complement all aspects of the care of cardiac surgery patients with AKI, from the initial approach of early AKI to fluid balance management during renal replacement therapy. The current evidence is reviewed, including knowledge gaps and future areas of research.
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Affiliation(s)
- William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Anesthesiology, Montreal Heart Institute, Montréal, Canada.
| | - André Denault
- Department of Anesthesiology, Montreal Heart Institute, Montréal, Canada; Division of Intensive Care, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Pierre Robillard
- Department of Radiology, Montreal Heart Institute, Montréal, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Montréal, Canada
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Parulekar P, Neil-Gallacher E, Harrison A. Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible. J Intensive Care Soc 2018; 19:313-318. [PMID: 30505345 DOI: 10.1177/1751143718762685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.
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Affiliation(s)
| | | | - Alex Harrison
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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