Abstract
BackgroundPoint of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be particularly useful in resource-limited settings. However, its impact on clinical decision making in such settings has not been well studied. The objective of this study is to describe the utilization and impact of PoCUS on clinical decision making at an urban emergency department in Dar es Salaam, Tanzania.MethodsThis was a prospective descriptive cross-sectional study of patients receiving PoCUS at Muhimbili National Hospital’s Emergency Medical Department (MNH EMD). Data on PoCUS studies during a period of 10 months at MNH EMD was collected on consecutive patients during periods when research assistants were available. Data collected included patient age and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic impression and disposition plan before and after PoCUS. Descriptive statistics, including medians and interquartile ranges, and counts and percentages, are reported. Pearson chi squared tests and p-values were used to evaluate categorical data for significant differences.ResultsPoCUS data was collected for 986 studies performed on 784 patients. Median patient age was 32 years; 56% of patients were male. Top indications for PoCUS included trauma, respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians reported that the use of PoCUS changed either diagnostic impression or disposition plan in 29% of all cases. Rates of change in diagnostic impression or disposition plan increased to 45% in patients for whom more than one PoCUS study type was performed.ConclusionsIn resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications and has substantial impact on clinical decision making, especially when more than one study type is performed.
Highlights
Point-of-care ultrasound (PoCUS) has been shown to improve diagnostic accuracy;[1–10] facilitate faster diagnosis, consultation and definitive treatment;[10–19] and decrease complication rates when used for procedural guidance.[20–23] Point of care ultrasound (PoCUS) is affordable and cost-effective,[19,22–25] has been shown to reduce the use of more invasive and expensive diagnostic modalities,[24–27] and has been shown to be effective when performed by a variety of clinical providers in a range of clinical settings.[27–36]All of these qualities make PoCUS suited for resource-limited settings where other imaging modalities may be unavailable, impractical, or expensive, and patient transfer for radiology services may be burdensome or impossible
Data on PoCUS studies during a period of 10 months at Muhimbili National Hospital’s Emergency Medical Department (MNH Emergency Medical Department (EMD)) was collected on consecutive patients during periods when research assistants were available
PoCUS data was collected for 986 studies performed on 784 patients
Summary
PoCUS is affordable and cost-effective,[19,22–25] has been shown to reduce the use of more invasive and expensive diagnostic modalities,[24–27] and has been shown to be effective when performed by a variety of clinical providers in a range of clinical settings.[27–36]. All of these qualities make PoCUS suited for resource-limited settings where other imaging modalities may be unavailable, impractical, or expensive, and patient transfer for radiology services may be burdensome or impossible. Point of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be useful in resource-limited settings.
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