Point-of-care Ultrasound in General Practice

A Systematic Review

Camilla Aakjær Andersen, MD; Sinead Holden, PhD; Jonathan Vela, MD; Michael Skovdal Rathleff, PhD; Martin Bach Jensen, MD, PhD

Disclosures

Ann Fam Med. 2019;17(1):61-69. 

In This Article

Abstract and Introduction

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.

Methods: We 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.

Results: We 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.

Introduction

Point-of-care ultrasound (POCUS) is described as the stethoscope of the future[1] and is being implemented across the medical field by clinicians for bedside examination of patients.[1–3] Evidence supports the idea that adding POCUS to the examination of selected patients leads to improved and earlier diagnosis in a hospital setting.[4–7] As a result, POCUS has been integrated into the curriculum in several medical schools[8,9]and medical specialist training programs.[10,11]

General practitioners are increasingly using POCUS in patient care.[11–13] Evidence from hospital settings cannot be directly transferred to general practice because of differences in the patient population and disease prevalence, and the limited time for consultations in general practice.[14,15] The use of ultrasonography is user dependent and requires appropriate training and quality assurance to ensure safety. Misinterpretations may lead to flawed diagnoses that could raise unnecessary concern in patients, and potentially delay proper treatment if a serious condition is overlooked. Currently, there is a lack of any systematic synthesis of evidence in the literature on POCUS use among general practitioners.

The primary objective of this study was to systematically review and synthesize the published literature regarding the use of ultrasonography by general practitioners and their training in its use. We aimed to identify which medical indications ultrasonography was used for, general practitioners' training, the quality of the scans performed, the frequency of use, the time required, potential harms, patient satisfaction, and financial costs associated with ultrasonography performed by general practitioners in practice or in training.

processing....