The study showed that, after a brief period of simple training, PUDs can be used successfully by physicians working in hospital wards, a specialist gastroenterology unit and general practice to reduce the number of referrals for further diagnostic tests in 10 common clinical indications, including gallstones, urinary stones, ascites and urinary retention.
Colli A, et al. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study. PLoS One. 2015;10(3):e0122181.
The standard technique identified 33 DVTs in 16 patients after scanning the iliac, femoral, popliteal, peroneal, tibial and soleal veins. All of the DVTs were also detected using the pocket-size ultrasound, resulting in a sensitivity and specificity of 100%.
Nakanishi K, et al. Detection of deep venous thrombosis using a pocket-size ultrasound examination device. JACC Cardiovasc Imaging. 2016;9(7):897-8.
Family doctors performed HCU in primary care, with the support of web-based remote expert interpretation, in patients with signs suggesting cardiovascular disease. The study showed that this method of scanning allowed significant heart diseases to be ruled out and improved triage for conventional echocardiography; however, agreement between family doctors and the experts varied depending on the specific cardiovascular disease.
Evangelista A, et al. Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation. Heart. 2016;102(5):376-82.
The study showed that ‘quick-scans’ detected significant structural disease in 10% of patients with focused indications in general practice, the most common of which were valve disease and left ventricular dysfunction. ‘Quick-scans’ were found to effectively extend the clinical examination and triage the need for standard transthoracic echocardiography.
Fabich N, et al. ‘Quick-scan’ cardiac ultrasound in a high-risk general practice population. Br J Cardiol. 2016;23(1):27-9.
This study suggests that a point-of-care device for diagnosis and referral reductions of pulmonary embolism/deep vein thrombosis is one of the most sought-after diagnostic tools among UK-based general practitioners. However, there still remain system-level barriers to their acquisition and implementation.
Turner PJ, et al. Point-of-care testing in UK primary care: a survey to establish clinical needs. Fam Pract. 2016;33(4):388-94.
GPs’ results from a <5-minute scan with a handheld ultrasound device were compared with those from a cardiologist <30 minutes afterwards using a laptop scanner and handheld ultrasound device. GPs were able to obtain a standard view and measure the septal mitral annular excursion in 87% of patients. There was no significant difference between the measurements obtained by the GPs and the cardiologists.
Mjølstad OC, et al. Assessment of left ventricular function by GPs using pocket-sized ultrasound. Fam Pract. 2012;29(5):534-40.
Based on data gathered through shadowing at a hospital’s DVT department over two days, the authors mapped a typical patient’s pathway through the hospital’s current system and suggested ways in which it could be optimised. The study found that there is a delay in patients receiving the ultrasound scan, which can lead to issues surrounding the self-administration and cost of low-molecular-weight heparin. The authors consider having nurse-led ultrasound procedures as a key component in improving the DVT patient journey.
Koizi P, et al. Improving the outcomes of deep vein thrombosis: optimising the diagnostic pathway. Thrombus. 2016;20(3):43-5.
Data from pre- and post-learning knowledge-based tests and surveys showed a significant increase in knowledge, with approximately 83% of students being able to capture acceptable or marginally acceptable images. 95% of students also claimed that the newly acquired ultrasonography knowledge enhanced their medical education.
Miller GT, et al. Learner improvement from a simulation-enhanced ultrasonography curriculum for first-year medical students. J Ultrasound Med. 2017;36(3):609-19.
This study showed that limited echocardiography for the detection of left ventricular hypertrophy performed by primary care physicians at the point of care was feasible. Future studies are needed to determine the ideal training and experience necessary to yield competency.
Bornemann P, et al. Assessment of primary care physicians’ use of a pocket ultrasound device to measure left ventricular mass in patients with hypertension. J Am Board Fam Med. 2015;28(6):706-12.
The use of PHHE after brief bedside training in the form of a tutorial greatly improved the clinical diagnosis of medical students and junior doctors, over and above history, physical examination and ECG findings.
Panoulas VF, et al. Pocket-size hand-held cardiac ultrasound as an adjunct to clinical examination in the hands of medical students and junior doctors. Eur Heart J Cardiovasc Imaging. 2013;14(4):323-30.
The safety, ease of use, rapid time to diagnosis, low cost and accessibility make bedside ultrasonography for DVT particularly useful for emergency and critical care clinicians. Patients who have risk factors for or symptoms and signs suggestive of DVT or pulmonary embolism should have work-ups that include, but are not necessarily limited to, bedside compression ultrasonography.
Grimm LJ. Bedside ultrasonography in deep vein thrombosis. Medscape. 2015.