The utility of Point-Of-Care Ultrasound (POCUS) in emergency department; an observational study

Abstract

Objective An observational study on the current diagnostic and procedural utility and impact of point of care ultrasound (POCUS) in Emergency Departments. Background POCUS has been recognised as a readily available, non-invasive imaging tool; providing prompt clinical information at the bedside, as well as a useful guiding tool during procedural interventions. However, its current use and clinical impact in ED remain unknown. Methods In October 2016, a 31-day prospective observational study was performed in three Monash Health Emergency Departments in Melbourne, Australia. Data regarding patients’ presenting complaints, frequency, operators’ qualifications and POCUS module were archived and analysed. Factors associated with diagnostic impacts were identified. Results A total of 390 (2.82%) POCUS examinations were performed among 18,355 (13,822 adults) presentationsin the three Monash Health EDs during the 31-day study period. 292 (74.9%) cases were retrieved from electronic medical records (Symphony), recorded as Clinician-Performed Ultrasound (CPU);and 98 (25.1%) cases from written records which were collected by research assistants. The POCUS was performed as a diagnostic tool in 344 (88.2%) and procedural in 46 (11.8%) cases. eFAST/AAA and BELS were the two most frequently utilised diagnostic modalities. Overall, the majority of diagnostic POCUS cases were in patients presented with abdominal pain (35.3%), chest pain (14.0%) and trauma mainly motor vehicle accidents (5.8%). Procedural POCUS was most commonly used for vascular access (71.7%), where dyspnoea (21.6%) was the most common presenting complaint. Most of the cases were performed by Senior Medical Staffs (66.4%). DiagnosticPOCUS overall sensitivity and specificity were 94.1% (95% CI 85.6 - 98.4%) and 99.6% (97.5 - 100%); positive and negative predictive values were 98.5% (95% CI 90.1 – 99.8%) and 98.2% (95% CI 95.6 – 99.3%), respectively. Conclusions Despite known diagnostic and procedural pros, the prevalence of POCUS in our EDs was found to be lower than what is expected and potentially beneficial in our population. In our study, POCUS mostly served for diagnostic purposes and demonstrated satisfactory diagnostic values. However, the true diagnostic and therapeutic impacts could not be elicited given the few numbers of cases. Prevalence is shown to be proportional to the level of clinical expertise among the operators. Training and utility of POCUS among physicians ought to be further advocated and supported.