Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

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. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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

“…The study population was selected, and a LUS examination was only performed when clinical concerns about hospital referral appeared. Although several systematic reviews have suggested the usefulness of US in PC, [11][12][13][14] we are unaware of the existence of studies on LUS in PC (and specifically in COVID-19).…”

Dermatologic Ultrasound in Primary Care: A New Modality of Teledermatology

“…Dermatologic ultrasound, which is increasingly used in dermatology, has also improved diagnostic accuracy when combined with the clinical examination 3,4 . Point‐of‐care ultrasound is also increasingly used, and family physicians and general practitioners have found that it is cost‐effective, enhances their clinical diagnosis, and obviates specialist consultations 5 . Although teleultrasound is comparable to in‐person consultation in obstetrics 6 and cardiology, 7,8 it has not been tested as an effective diagnostic method in dermatology.…”

“…3,4 Point-of-care ultrasound is also increasingly used, and family physicians and general practitioners have found that it is cost-effective, enhances their clinical diagnosis, and obviates specialist consultations. 5 Although teleultrasound is comparable to in-person consultation in obstetrics 6 and cardiology, 7,8 it has not been tested as an effective diagnostic method in dermatology. This study aimed to validate dermatologic ultrasound as a complementary tool in teledermatology.…”

Accuracy of lung ultrasonography in the hands of non-imaging specialists to diagnose and assess the severity of community-acquired pneumonia in adults: a systematic review

“…The ability of LUS to accurately diagnose pneumonia early in the course of the disease may improve outcomes for patients attending primary care. 43 Furthermore, improved diagnostic performance in patients with suspected CAP may reduce the need for antibiotics. On the other hand, the size of pulmonary lesions might be smaller in the early stages of disease and the results indicate that the usability of LUS to diagnose CAP is compromised by its inability to visualise pulmonary lesions that are not in contact with the pleura.…”