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

Abstract

PURPOSE Ultrasound examinations are currently being implemented in general practice. This study aimed to systematically review the literature on the training in and use of point-of-care ultrasound (POCUS) by general practitioners. METHODSWe followed the Cochrane guidelines for conduct and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. We searched the databases MEDLINE (via PubMed), EMBASE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials using the key words ultrasonography and general practice in combination and using thesaurus terms. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist. RESULTSWe included in our review a total of 51 full-text articles. POCUS was applied for a variety of purposes, with the majority of scans focused on abdominal and obstetric indications. The length of training programs varied from 2 to 320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused POCUS scans were reported to have a higher diagnostic accuracy and be associated with less harm than more comprehensive scans or screening scans. The included studies were of a low quality, however, mainly because of issues with design and reporting.CONCLUSIONS POCUS has the potential to be an important tool for the general practitioner and may possibly reduce health care costs. Future research should aim to assess the quality of ultrasound scans in broader groups of general practitioners, further explore how these clinicians should be trained, and evaluate the clinical course of patients who undergo scanning by general practitioners.Annals Journal Club selection; see inside back cover or http://www.Ann FamMed.org/AJC/.To read or post commentaries in response to this article, see it online at http://www.AnnFamMed.org/content/17/1/61.

Point-of-care ultrasound (POCUS) in Norwegian general practice

“…In Norway, a few general practitioners (GPs) have used ultrasound over the last 40 years for a variety of clinical problems [1,2]. As ultrasound devices have evolved, the term point-of-care ultrasound (POCUS) has become established in the field of general practice and became a major trend after 2000 [3][4][5][6][7][8][9]. POCUS is a focused examination of patient symptoms as a part of the diagnostic process that includes anamnesis and physical-and laboratory examinations, and is less comprehensive than a full diagnostic ultrasound by radiologists.…”

Comment on: Using Point‐of‐Care Ultrasound on Home Visits

“…[3][4][5][6] We would be concerned if our proposal set the standard for integrating POCUS into a home visit too high, requiring the large number of supervised scans or expensive machine capabilities described for abdominal or musculoskeletal applications. 7,8 As the quality of ultrasound devices continues to improve and more providers use them in limited-resource settings, we anticipate an expansion of the HOUSE protocol to include a wider array of ultrasound examinations that are relevant to home care programs.…”

“…POCUS of the abdomen to evaluate for fecal load, hepatic pathology and gallstones, and abdominal vascular issues, including abdominal aortic aneurysm, has been shown to be relatively easy to learn and helpful in diagnosis and management of abdominal conditions. 8,9 Abdominal POCUS has also been found to be beneficial for home hospice providers, to evaluate for ascites and even assist with ultrasound-guided paracentesis in the home. 10 This is an exciting time in medicine, with increasing adoption of POCUS and wider availability of affordable, portable ultrasound devices.…”

Modern Landscapes and Strategies for Learning Ultrasound in Rheumatology

“…[3][4][5][6] We would be concerned if our proposal set the standard for integrating POCUS into a home visit too high, requiring the large number of supervised scans or expensive machine capabilities described for abdominal or musculoskeletal applications. 7,8 As the quality of ultrasound devices continues to improve and more providers use them in limited-resource settings, we anticipate an expansion of the HOUSE protocol to include a wider array of ultrasound examinations that are relevant to home care programs.…”