The Use of a Pocket-Sized Ultrasound Device Improves Physical Examination: Results of an In- and Outpatient Cohort Study

Abstract

BackgroundThe performance of pocket mobile ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit.AimWe assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings.MethodsWe conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians’ judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing.FindingsThe 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%.ConclusionsAfter a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.

Point-of-Care Ultrasound in General Practice: A Systematic Review

“…Ultrasonography used for examining the aorta or lungs, or for obstetric conditions had a higher diagnostic accuracy than ultrasonography used for heart or abdominal examinations. The quality estimate was higher in studies with focused abdominal POCUS scans (ie, scans limited to answering specific clinical questions, 32,51 such as whether ascites was present) than in studies entailing more explorative examinations. 47,57,58 Limited cardiac examinations 20,52 also had a higher quality estimate than more extensive examinations.…”

Bedside screening with the use of pocket‐size imaging device can be useful for ruling out carotid artery stenosis in patients scheduled for cardiac surgery

“…From an economical viewpoint, it is important to address the question whether expanded physical examination with the use of PSID could identify patients who require further testing. Colli et al . in their study involving 195 physicians who examined 1962 patients concluded that supplementing the physical examination with a brief assessment by means of PSID can reduce the need for further testing in various clinical situations.…”

Thoracic Ultrasound: What Non-radiologists Need to Know

“…The recent advent of handheld machines and smartphone probe attachments potentially allow for USS assessment as part of routine clinical examination. Colli et al demonstrated that the use of pocket USS in combination with clinical examination obviated the need for further testing in 95% of patients for whom there was a clinical question of pleural effusion [54]. Another pilot study demonstrated that use of pocket USS by a medical student could screen for the presence of left ventricular systolic dysfunction with a similar sensitivity and specificity to an experienced echocardiologist [55].…”