Abstractobjectives To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low-and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.methods The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.results A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).conclusions Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

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In an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physician's initial diagnostic impression. There were no differences in 24-h mortality and a number of patient care interventions.

Long-term ultrasound knowledge and skill retention was high after a brief and intensive training intervention at an academic tertiary hospital in Ghana. Clinicians reported improvements in patient care and local practice patterns.

IntroductionRespiratory failure is commonly seen in African emergency centres and intensive care units, but little is known about the need for intubation and mechanical ventilation.MethodsFrom April to October 2017, we recorded the number of patients intubated and ventilated in the emergency centre and intensive care unit at Komfo Anokye Teaching Hospital in Kumasi, Ghana on a daily basis. We assessed patients for presence of acute respiratory distress syndrome (ARDS) using the Kigali Modification of the Berlin ARDS criteria. ARDS patients were re-assessed daily.ResultsDuring the study period, 102 patients were intubated, of which 82 were assessed by the study team. The remaining 20 patients died before they could be assessed. Two (2.4%) patients were identified as having ARDS, and both died. Neither was treated with prone positioning or chemical paralysis. It is possible that many of the patients who died before an assessment suffered from ARDS, considering its associated high mortality, and thus the true incidence of ARDS may have been higher.ConclusionRespiratory failure requiring intubation and mechanical ventilation is common in patients presenting to the emergency centre or intensive care unit at an academic tertiary care centre in Ghana. The true incidence of ARDS was likely underestimated by our study.

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Study Objectives: Intussusception is a pediatric abdominal emergency that requires prompt diagnosis, as delays can lower air enema reduction success rates. Point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians has emerged as a promising tool for diagnosing intussusception. The primary objective of this study was to evaluate the accuracy of PEM physician-performed POCUS in identifying ileocolic intussusception. The secondary objective was to identify factors that predict air enema failure.Methods: This retrospective study included children who underwent POCUS for suspected ileocolic intussusception in a pediatric emergency department. Patients were included in the study if they presented between January 2001 and December 2015, and had POCUS performed by one of three PEM physicians. PEM physicians were trained in standard POCUS techniques/indications, and subsequently underwent brief additional education in identification of ileocolic intussusception. A pediatric radiologist confirmed POCUS scan interpretation by either direct over-read of the POCUS images, or by radiology department ultrasound. Data collected included demographic variables, duration of symptoms, location of intussusception, air enema success/failure, need for surgery, and recurrence of intussusception. Data analysis included descriptive statistics, sensitivity, specificity, and positive and negative predictive values of POCUS.Results: 105 POCUS scans were performed on 104 patients. Mean age was 22 months (range 2 to 88 months) and 67/104 (64.4%) were male. There were 78 patients with intussusception; 75/78 were detected by POCUS (Figure 1). PEM physician-performed POCUS had a sensitivity of 96.2% (95% CI 91.9-99.2), specificity of 92.6% (95% CI 82.7-100), positive predictive value of 97.4% (95% CI 93.9-100), and negative predictive value of 89.3% (95% CI 77.8-100). Seventy-five children underwent air enema, 54 had successful reduction, and 21 required surgery. Three children had spontaneous resolution and did not require air enema. Intussusception distal to the splenic flexure was found to be associated with unsuccessful air enema (OR 11.48, p¼<0.01). Sex, duration of symptoms, and history of recurrent intussusception were not found to be predictors of air enema failure.Conclusions: PEM physician-performed POCUS accurately identified ileocolic intussusception when compared with radiologist interpretation. Intussusception located distal to the splenic flexure was a strong predictor of air enema failure. POCUS is a promising diagnostic modality in prompt diagnosis of intussusception, but needs further prospective study.