Pocket-sized ultrasound device (PUD) use assists physicians in making more accurate diagnoses

Results from a study presented at The International Liver Congress™ 2015 demonstrate that the use of a pocket-sized ultrasound device (PUD) helps to reduce the need for further testing in both the inpatient and outpatient setting.

The study evaluated the effectiveness of the PUD when testing for the following conditions: biliary-duct dilation, gallstones, ascites, splenomegaly, pleural effusion, pericardial effusion, urinary retention, urinary stones, abdominal mass and aortic aneurysm.

PUDs offer a comparable performance to standard ultrasonography, however the accuracy of a physical examination is often poor meaning that further tests are required. This study assessed whether adding the use of PUD to physical examination could lead to a reduction in the rate of additional tests.

Of the 1,962 patients included in the study:

  • 726 (37%) were inpatients, 510 (26%) were hepatology outpatients and 726 (37%) were recruited from GPs
  • Gallstones (37%), ascites - excessive accumulation of fluid in the abdominal cavity (17%), pleural effusion (13%), urinary stones (13%) and urinary retention (12%) accounted for more than 90% of the clinical questions, confirmed by PUD in 66% of cases
  • The overall frequency of further tests needed after PUD was 37%
  • The rate of agreement between findings of the PUD and additional tests was 89%

This study found that after basic training, the use of a PUD offers a simple and effective way to improve the accuracy of diagnosis and reduce the number of tests a patient needs.

Abstract O121: THE USE OF A POCKET-SIZED ULTRASOUND DEVICE IMPROVES PHYSICAL EXAMINATION: RESULTS OF AN IN- AND OUTPATIENT STUDY

Agostino Colli* 1, Daniele Prati2, Mirella Fraquelli3, 4, Sergio Segato5, Pier Paolo Vescovi6, Fabrizio Colombo7, Carlo Balduini8, Alessandra Baccarin4, Serena Della Valle1, Dario Conte4, Giovanni Casazza9

1 Department of Internal Medicine, Ospedale A. Manzoni ,
2 Department of Transfusion Medicine and Hematology, Ospedale A Manzoni , Lecco,
3 Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit,
4 Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Milano,
5 Gastroenterology and GI Endoscopy, , Azienda Ospedaliero Universitaria Macchi, Varese,
6 Division of Internal Medicine , Azienda Ospedaliera "Carlo Poma",
7 Division of Internal Medicine, Azienda Ospedaliera Niguarda, Milano,
8 Division of Internal Medicine, Fondazione IRCCS Policlinico San Matteo-Università degli Studi, Pavia,
9 Deparment of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy

Background and Aims: The performance of pocket-sized ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit. Accordingly, present cohort impact study was aimed at assessing whether the use of PUD in the context of physical examination could reduce the request rate of additional tests when used by physicians in different clinical settings.

Methods: The study involved medical wards(#4), hepatological outpatient clinic (#1) and 90 GPs operating in the same geographical area. After a short predefined training course 135 physicians used PUD in addition to physical examination in 1962 consecutive patients to investigate ten well-defined clinical hypotheses (biliary-duct dilation/ gallstones, ascites, splenomegaly, pleural /pericardial effusion, urinary retention/ stones, abdominal mass/ aortic aneurysm) . PUD related findings were recorded. and the decision as to whether to request further tests was left to the physician clinical judgement. The main outcome was to define the proportion of cases undergoing additional tests after PUD. An accurate report of the frequency of the clinical questions in the different settings was also planning , using logistic regression analysis to assess the determinant(s) of the primary outcome.

Results: Of the 1962 patients included 726 (37%) were inpatients, 510 (26%) hepatology outpatients and 726 (37%) recruited from GPs. Gallstones (37%), ascites (17%), pleural effusion (13%), urinary stones (13%) and urinary retention (12%) accounted for >90% of the clinical questions, confirmed by PUD in 66% of cases. The overall frequency of further tests after PUD was 37%; and logistic was associated with both the clinical questions and settings (p<0.01). The rate of agreement between findings at PUD and additional tests was 89%, with a sensitivity of 91% and a specificity of 83% ( LR+ 5.4; LR- 0.11).

Conclusions: After a simple and short training, a PUD examination can be used in addition to a physical examination in both in- and outpatients to improve the answer to ten common clinical questions, thus reducing the need further testing.

Disclosure of Interest: None Declared

Presenter: Agostino Colli (Italy)