Trends in Ultrasound Use in Low and Middle Income Countries: A Systematic Review

Stewart, Kelsey A.; Navarro, Sergio M.; Kambala, Sriharsha; Tan, Gail; Poondla, Revanth K.; Lederman, Sara; Barbour, Kelli; Lavy, Chris

doi:10.21106/ijma.294

Cited by 88 publications

(84 citation statements)

References 48 publications

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“… 73 However, with the availability of smaller and cheaper devices and a growing body of evidence, wider use of LUS can be foreseen. 74 , 75 Although cost-effectiveness studies in LMICs are lacking, LUS has been shown to reduce the use of CXR and chest CT in resource-rich ICUs, with less radiation exposure and lower costs. 76 , 77 …”

Section: Questionsmentioning

confidence: 99%

Pragmatic Recommendations for the Use of Diagnostic Testing and Prognostic Models in Hospitalized Patients with Severe COVID-19 in Low- and Middle-Income Countries

Schultz

Gebremariam

Park³

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Management of patients with severe or critical COVID-19 is mainly modeled after care of patients with severe pneumonia or acute respiratory distress syndrome from other causes. These models are based on evidence that primarily originates from investigations in high-income countries, but it may be impractical to apply these recommendations to resource-restricted settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for microbiology and laboratory testing, imaging, and the use of diagnostic and prognostic models in patients with severe COVID-19 in LMICs. For diagnostic testing, where reverse transcription–PCR (RT-PCR) testing is available and affordable, we recommend using RT-PCR of the upper or lower respiratory specimens and suggest using lower respiratory samples for patients suspected of having COVID-19 but have negative RT-PCR results for upper respiratory tract samples. We recommend that a positive RT-PCR from any anatomical source be considered confirmatory for SARS-CoV-2 infection, but, because false-negative testing can occur, recommend that a negative RT-PCR does not definitively rule out active infection if the patient has high suspicion for COVID-19. We suggest against using serologic assays for the detection of active or past SARS-CoV-2 infection, until there is better evidence for its usefulness. Where available, we recommend the use of point-of-care antigen-detecting rapid diagnostic testing for SARS-CoV-2 infection as an alternative to RT-PCR, only if strict quality control measures are guaranteed. For laboratory testing, we recommend a baseline white blood cell differential platelet count and hemoglobin, creatinine, and liver function tests and suggest a baseline C-reactive protein, lactate dehydrogenase, troponin, prothrombin time (or other coagulation test), and D -dimer, where such testing capabilities are available. For imaging, where availability of standard thoracic imaging is limited, we suggest using lung ultrasound to identify patients with possible COVID-19, but recommend against its use to exclude COVID-19. We suggest using lung ultrasound in combination with clinical parameters to monitor progress of the disease and responses to therapy in COVID-19 patients. We currently suggest against using diagnostic and prognostic models as these models require extensive laboratory testing and imaging, which often are limited in LMICs.

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Section: Questionsmentioning

confidence: 99%

Pragmatic Recommendations for the Use of Diagnostic Testing and Prognostic Models in Hospitalized Patients with Severe COVID-19 in Low- and Middle-Income Countries

Schultz

Gebremariam

Park³

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…Additionally to known benefits, ultrasound (LUS in particular) can be readily learned by a variety of medical professionals, not just radiological, to allow for rapid assessment and treatment in a variety of settings. Ultrasound devices can be used by a single operator, handheld, and can provide diagnostic capabilities at a much lower cost than other imaging tools such as CT or magnetic resonance imaging (MRI) and, in rural regions of LMICs, also compared with to traditional radiology [ 45 ]. These features make ultrasound an attractive option for clinical use in LMICs for both inpatient and outpatient use.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have demonstrated the diagnostic utility of ultrasound in the medical, surgical, and obstetric fields in LMICs [ 46 , 47 ]. This has led to the increase in point-of-care ultrasound (POCUS) in LMICs [ 45 ], which is done by the doctor in real time and at the bedside [ 48 ]. Studies have shown that doctors and other healthcare professionals can perform effective and accurate scans after 3 h of teaching and about 5 h of practice [ 49 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of lung ultrasound in low- to middle-income countries: a new challenge global health?

Buonsenso

2021

Eur J Pediatr

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Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. What is Known: • Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. What is New: • We discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting.

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“…A recent systematic review examining the trends in the use of POCUS in LMICs found the number of countries reporting use of ultrasound had grown from 50 to 62, with 70% of the included studies originating from Southeast Asia or sub-Saharan Africa. 35 In addition, studies have demonstrated that POCUS skills can be effectively taught to both physicians and nonphysician clinicians in resource-limited settings. 36 , 37 It remains to be seen if POCUS has the ability to effectively improve patient outcomes, although a single-center study from Tanzania demonstrated that POCUS resulted in earlier initiation of therapy, ranging widely from initiation of antibiotics to use of anticoagulants to surgical intervention, due to more rapid and accurate diagnosis.…”

Section: Questionsmentioning

confidence: 99%

Pragmatic Recommendations for the Management of COVID-19 Patients with Shock in Low- and Middle-Income Countries

Maximous

Brotherton

Achilleos

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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As some patients infected with the novel coronavirus progress to critical illness, a subset will eventually develop shock. High-quality data on management of these patients are scarce, and further investigation will provide valuable information in the context of the pandemic. A group of experts identify a set of pragmatic recommendations for the care of patients with SARS-CoV-2 and shock in resource-limited environments. We define shock as life-threatening circulatory failure that results in inadequate tissue perfusion and cellular dysoxia/hypoxia, and suggest that it can be operationalized via clinical observations. We suggest a thorough evaluation for other potential causes of shock and suggest against indiscriminate testing for coinfections. We suggest the use of the quick Sequential Organ Failure Assessment (qSOFA) as a simple bedside prognostic score for COVID-19 patients and point-of-care ultrasound (POCUS) to evaluate the etiology of shock. Regarding fluid therapy for the treatment of COVID-19 patients with shock in low-middle–income countries, we favor balanced crystalloids and recommend using a conservative fluid strategy for resuscitation. Where available and not prohibited by cost, we recommend using norepinephrine, given its safety profile. We favor avoiding the routine use of central venous or arterial catheters, where availability and costs are strong considerations. We also recommend using low-dose corticosteroids in patients with refractory shock. In addressing targets of resuscitation, we recommend the use of simple bedside parameters such as capillary refill time and suggest that POCUS be used to assess the need for further fluid resuscitation, if available.

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Trends in Ultrasound Use in Low and Middle Income Countries: A Systematic Review

Cited by 88 publications

References 48 publications

Pragmatic Recommendations for the Use of Diagnostic Testing and Prognostic Models in Hospitalized Patients with Severe COVID-19 in Low- and Middle-Income Countries

Pragmatic Recommendations for the Use of Diagnostic Testing and Prognostic Models in Hospitalized Patients with Severe COVID-19 in Low- and Middle-Income Countries

Implementation of lung ultrasound in low- to middle-income countries: a new challenge global health?

Pragmatic Recommendations for the Management of COVID-19 Patients with Shock in Low- and Middle-Income Countries

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