Validez de la ecografía abdominal en Atención Primaria para detección de aneurisma de aorta abdominal en varones de entre 65 y 75 años

Bravo-Merino, Laura; González-Lozano, Noelia; Maroto-Salmón, Ruth; Meijide-Santos, G.; Suárez-Gil, Patricio; Fañanás-Mastral, Ana

doi:10.1016/j.aprim.2017.10.005

Cited by 14 publications

(5 citation statements)

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“…Esquerrà et al found notably similar results for the detection of biliary lithiasis by general practitioners [ 24 ]. Bravo et al [ 25 ], Blois [ 26 ] and Bailey et al [ 27 ] arrived at the same conclusions for abdominal aortic aneurysms. Nixon et al assessed general practitioners in rural hospitals in New Zealand in renal POCUS and found good performance in relation to hydronephrosis (se.…”

Section: Discussionmentioning

confidence: 60%

Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

Camard,

Liard,

Duverne

et al. 2024

BMC Med Educ

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Context Point-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored. Objective The objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions. Method We used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training. Results 11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of “7–9” ratings) and 19 skills with a relative agreement (100% of “5–9” ratings). Conclusion These skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.

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Section: Discussionmentioning

confidence: 60%

Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

Camard,

Liard,

Duverne

et al. 2024

BMC Med Educ

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“…in % (95% CI)Sp. in % (95% CI)LR+ (95% CI)LR− (95% CI)AAA (> 3 cm)—screening in general practiceBravo-Merino et al [90]GP2019SpainNR7617 b /4.6 c 70Vascular surgical services ultrasound100 b /93.3 (75.4–99.9) c 100 b /98.5 (94.3–100) c ∞ b /62.2 c 0 b /0.07 c Blois et al [88]GP2012CanadaNR454.473Radiologist100 (15.8–100) a 100 (91.8–100) a ∞ a 0 a Bailey et al [89]GP2001USA2 h.795.1NRRadiologist100 (39.8–100) a 100 (95.2–100) a ∞ a 0 a AAA on clinical indication (cm) > 3 Rubano et al [ 94 ] EP 2013 MA ( 7 ) NR 655 23 > 50 CT, MRI, radiologist US, aortography, surgical findings, autopsy 99 ( 96 – 100 ) 98 ( 97 – 99 ) NR ( 10.8 – ∞ ) NR ( 0 – 0.025 ) > 5Lindgaard and Risgaard [93]GP2017Denmark2 d.293NRRadiologist US100 (2.5–100) a 100 (87.7–100) a ∞ a 0 a …”

Section: Resultsmentioning

confidence: 99%

“…Screening for abdominal aortic aneurysms (AAA) by GPs would require a very high accuracy to avoid false positive in a relatively low pre-test probability population, even if one selects the population who is at risk, men who have smoked in the ages between 65 and 75. We identified three small studies of GPs’ screening for AAA in such populations against a gold standard [88–90]. All found 100% accuracy for AAA greater than 3 cm and concluded screening by GPs were feasible.…”

Section: Resultsmentioning

confidence: 99%

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

Sorensen¹,

Hunskaar

2019

Ultrasound J

104

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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.

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“…Moreover, large AAAs (over 55 mm) are at a high risk of rupture and should be considered for surgical repair [79]. US examinations must be performed from the epigastrium to the distal bifurcation, and they should describe the aorta's caliber and shape and differentiate between flap dissection and thrombosis within its lumen [80,81]. Furthermore, an AAA rupture and hemoperitoneum should always be ruled out [3].…”

Section: (B) Appendicitis and Cholecystitismentioning

confidence: 99%

The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting

D’Andrea

Giudice

Fabiani

et al. 2023

IJERPH

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Point-of-care ultrasonography (POCUS) represents a goal-directed ultrasound examination performed by clinicians directly involved in patient healthcare. POCUS has been widely used in emergency departments, where US exams allow physicians to make quick diagnoses and to recognize early life-threatening conditions which require prompt interventions. Although initially meant for the real-time evaluation of cardiovascular and respiratory pathologies, its use has been extended to a wide range of clinical applications, such as screening for deep-vein thrombosis and trauma, abdominal ultrasonography of the right upper quadrant and appendix, and guidance for invasive procedures. Moreover, recently, bedside ultrasounds have been used to evaluate the fluid balance and to guide decongestive therapy in acutely decompensated heart failure. The aim of the present review was to discuss the most common applications of POCUS in the emergency setting.

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Validez de la ecografía abdominal en Atención Primaria para detección de aneurisma de aorta abdominal en varones de entre 65 y 75 años

Abstract: The ultrasound performed by GPs for the detection of AAA had high diagnostic validity. Further studies on the effectiveness should be conducted in order to assess the appropriateness of introducing a system of early detection of AAA in the risk population.

Cited by 14 publications

References 10 publications

Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

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

The Incremental Role of Multiorgan Point-of-Care Ultrasounds in the Emergency Setting

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