Point-of-care ultrasound shows diagnostic, cost-saving potential
Point-of-care ultrasound provided diagnostic capabilities in several clinical areas and reduced costs, according to a systematic review recently published in Annals of Family Medicine.
“Point-of-care ultrasound is the future stethoscope for every clinician. Point-of-care ultrasound empowers the primary care physician by providing more diagnostic information or increasing precision in clinical procedures,” Camilla Aakjær Andersen, MD, of Aalborg University Fyrkildevej in Denmark, told Healio Primary Care Today.
She explained several potential benefits.
“The physician may bring the ultrasound scanner to the patient’s home to aid diagnosis, such as estimating if there is residual urine or ascites in a patient at the nursing home with an enlarged abdomen,” she said. “The physician may also use point-of-care ultrasound to guide simple clinical procedures, such as venous access or joint injections, as point-of-care ultrasound allows the physician to locate and follow the needle’s way through the tissue real-time on the screen. This way, precision improves.”
The 51 studies Andersen and colleagues reviewed reported that point-of-care ultrasound provided:
- for the heart, diagnostic accuracy sensitivity between 73% to 77% and specificity of between 75% to 85%;
- for the aorta, diagnostic accuracy sensitivity of 100% and specificity of 100%;
- for obstetric conditions, diagnostic accuracy sensitivity of 97% and specificity of 98%;
- for the lung, diagnostic accuracy sensitivity of 92% and specificity of 95%;
- for the kidney, diagnostic accuracy sensitivity of 82% and specificity of 99%;
- for other locations, such as musculoskeletal and urinary areas, diagnostic accuracy sensitivity of between 91% to 98% and specificity of between 83% and 95%.
False positives were reported in:
- 0.7% to 3.2% of obstetric examinations;
- 0.5% to 9.9% of abdominal examinations;
- 4% to 33.3% of all cardiac examinations;
- 93% of renal cell carcinoma examinations;
- 9.7% to 12.1% of broad health-check screenings;
- 18% of carotid artery screenings; and
- 21.4% of aorta screenings.
Neither learning to use point-of-care ultrasound, nor using it on patients, requires a significant amount of time, Andersen in the interview.
“Our review showed that competence in some simple examinations can be achieved after only a few hours of training,” she said. “Our review also showed that ultrasound examinations in primary care were not time-consuming — most examinations were performed in less than 10 minutes. Furthermore, ultrasound examinations seemed to be in line with patient preferences.”
As with most technologies, the price of point-of-care ultrasound has gone down, potentially enabling more PCPs to take advantage of the tool, Andersen said. The review also found 65.6% of point-of-care-ultrasound scans removed the need for further testing, and 83% of patients were willing to pay extra to have an ultrasound examination performed by a general practitioner, suggesting other potential cost-saving opportunities to its use.
Research independent of Andersen and colleagues’ findings suggest point-of-care ultrasound has not reached its full potential: A 2015 Family Medicine study found only 12.1% of 224 U.S. family medicine residency directors reported “familiarity with the literature that supports the use of point-of-care ultrasound” at a patient’s bedside besides obstetrical uses, and a 2017 Prescient & Strategic Intelligence press release reported the worldwide market for the device is expected to grow about 7% by 2025, due largely to the increasing number of older adults, growing occurrence of chronic diseases, and rising health care costs.
Andersen said there are some unknowns surrounding the device, which could set the stage for future research involving point-of-care ultrasound.
“Challenges remain in developing guidelines to support clinical decision-making attached to the use of point-of-care ultrasound in primary care and training programs aimed at primary care point-of-care ultrasound. We also need research that explores the long-term effects of this ultrasound in order to determine which examinations are best suited for primary care,” she said. – by Janel Miller
Andersen CA, et al. Ann Fam Med. 2019;doi:10.1370/afm.2330.
Hall JWW, et al. Fam Med. 2015;47(9):706-11.
Prescient & Strategic Intelligence. Point-of-Care Ultrasound (PoCUS) device market to grow at 6.9% CAGR till 2025: P&S market research. https://globenewswire.com/news-release/2017/07/21/1055557/0/en/Point-of-Care-Ultrasound-PoCUS-Device-Market-to-Grow-at-6-9-CAGR-till-2025-P-S-Market-Research.html. Accessed Feb. 4, 2019.
Disclosures: Andersen reports no relevant financial disclosures. Please see the other studies for those authors’ relevant financial disclosures.