Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device

Abstract

Purpose The aim of the current study was to evaluate point of care ultrasound (POCUS) in geriatric patients by echoscopy using a handheld ultrasound device (HHUSD, VScan) at bedside in comparison to a high-end ultrasound system (HEUS) as the gold standard. Materials and Methods Prospective observational study with a total of 112 geriatric patients. The ultrasound examinations were independently performed by two experienced blinded examiners with a portable handheld device and a high-end ultrasound device. The findings were compared with respect to diagnostic findings and therapeutic implications. Results The main indications for the ultrasound examinations were dyspnea (44.6 %), fall (frailty) (24.1 %) and fever (21.4 %). The most frequently found diagnoses were cystic lesions 32.1 % (35/109), hepatic vein congestion 19.3 % (21/109) and ascites 13.6 % (15/110). HHUSD delivered 13 false-negative findings in the abdomen resulting in an “overall sensitivity” of 89.5 %. The respective “overall specificity” was 99.6 % (7 false-positive diagnoses). HHUSD (versus HEUS data) resulted in 13.6 % (17.3 %) diagnostically relevant procedures in the abdomen and 0.9 % (0.9 %) in the thorax. Without HHUSD (HEUS) 95.7 % (100 %) of important pathological findings would have been missed. Conclusion The small HHUSD tool improves clinical decision-making in immobile geriatric patients at the point of care (geriatric ward). In most cases, HHUSD allows sufficiently accurate yes/no diagnoses already at the bedside, thereby clarifying the leading symptoms for early clinical decision-making.

Modern ultrasound imaging of pancreatic tumors

“…1, 2) [63]. The value of handheld point-of-care devices remains to be determined [68][69][70][71][72].…”

Implementation of a strategy involving a multidisciplinary mobile unit team to prevent hospital admission in nursing home residents: protocol of a quasi-experimental study (MMU-1 study)

“…The multidisciplinary skills of MMU-1 staff, that may involve expert physicians with different skills and background depending on the clinical problem of patients, represents a novelty at the current literature state of the art and has a great potential of being successful in preventing hospital admission, considering the high clinical complexity of nursing home residents. The use of bedside ultrasound equipment also represents a high value added to the care of these patients, allowing to reach a high diagnostic accuracy and to perform invasive procedures without moving patients to the hospital 29 30. The use of bedside ultrasonography in geriatrics is becoming increasingly popular but is generally unavailable in nursing homes 29 30.…”

“…The use of bedside ultrasound equipment also represents a high value added to the care of these patients, allowing to reach a high diagnostic accuracy and to perform invasive procedures without moving patients to the hospital 29 30. The use of bedside ultrasonography in geriatrics is becoming increasingly popular but is generally unavailable in nursing homes 29 30. When integrated with an accurate physical examination, bedside ultrasonography can dramatically improve the diagnostic process,31 especially in geriatric multimorbid patients where severity of symptoms, cognitive impairment and mobility limitations may reduce the accuracy of traditional imaging 29 30…”

“…The use of bedside ultrasonography in geriatrics is becoming increasingly popular but is generally unavailable in nursing homes 29 30. When integrated with an accurate physical examination, bedside ultrasonography can dramatically improve the diagnostic process,31 especially in geriatric multimorbid patients where severity of symptoms, cognitive impairment and mobility limitations may reduce the accuracy of traditional imaging 29 30…”

Chest ultrasound in Italian geriatric wards: use, applications and clinicians’ attitudes

“…Changes of acoustic impedance of the chest wall related to aging and age-related chronic diseases should be also considered as another important factor limiting the use of thoracic ultrasound in geriatric medicine 12 . However, the scientific literature supports the use of chest ultrasound even in older patients with the worst clinical conditions and performance status for assisting the diagnostic workup of respiratory diseases, implying several positive consequences on clinical decision making [13][14][15] . In 2018, the Italian Society of Gerontology and Geriatrics (SIGG) has promoted a research group on chest ultrasound in geriatrics (Gruppo di Ricerca sull'Ecografia Toracica nell'Anziano -GRETA), to improve the understanding of the current use of chest ultrasound in Italian geriatric wards and promote research projects on this theme.…”