Point-of-care ultrasound in primary care

Previously, ultrasound examinations have been performed by specialized personnel using advanced scanning devices. But with the current development in technology the devices are now smaller, more portable as well as cheaper, and thus more available also to clinicians in primary care.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut201934 Registration no: SBU 2019/343

Question

What scientific studies are there investigating the use of point-of-care ultrasound in primary care?

Identified literature

One systematic review with high risk of bias [1] and eight primary studies [2-9] were found relevant for the question. The primary studies were not assessed for risk of bias.

References

  1. Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Ann Fam Med 2019;17:61-69.
  2. Blois B. Office-based ultrasound screening for abdominal aortic aneurysm. Can Fam Physician 2012;58:e172-8.
  3. Bornemann P, Johnson J, Tiglao S, Moghul A, Swain S, Bornemann G, 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;28:706-12.
  4. Evangelista A, Galuppo V, Méndez J, Evangelista L, Arpal L, Rubio C, et al. Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation. Heart 2016;102:376-82.
  5. Greenlund LJS, Merry SP, Thacher TD, Ward WJ. Primary Care Management of Skin Abscesses Guided by Ultrasound. Am J Med 2017;130:e191-e193.
  6. Karjalainen JP, Riekkinen O, Kröger H, Jurvelin JS. Ultrasound method for osteoporosis diagnostics at primary healthcare. Osteoporos Int 2012;23:S244-S245.
  7. Karjalainen JP, Riekkinen O, Toyras J, Jurvelin JS, Kroger H. New method for point-of-care osteoporosis screening and diagnostics. Osteoporos Int 2016;27:971-7.
  8. Lindgaard K, Riisgaard L. 'Validation of ultrasound examinations performed by general practitioners'. Scand J Prim Health Care 2017;35:256-61.
  9. Nilsson G, Soderstrom L, Alverlind K, Samuelsson E, Mooe T. Hand-held cardiac ultrasound examinations performed in primary care patients by nonexperts to identify reduced ejection fraction. BMC Med Educ 2019;19:282.

Literature search

PubMed via NLM 2019-10-03
Point-of-care ultrasound in primary care
Search terms Items found
The search result, usually found at the end of the documentation, forms the list of abstracts.; [mh] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [mh:noexp] = Does not include terms found below this term in the MeSH hierarchy; [majr] = MeSH Major Topic; [tiab] = Title or abstract; [ti] = Title; [au] = Author; [tw] = Text Word; Systematic[sb] = Filter for retrieving systematic reviews; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1. Family practice[mh:noexp] OR Family physicians[mh:noexp] OR Community health services[mh:noexp] OR Primary care[tiab] OR General practi*[tiab] OR Primary health*[tiab] OR Community health*[tiab] OR Family practic*[tiab] OR Family medicine[tiab] OR Family physician*[tiab] 289 570
Intervention:
2. "Ultrasonography"[Mesh] OR "Diagnostic Imaging"[Mesh] 2 562 988
3. ultraso*[Title/Abstract] OR sonogra*[Title/Abstract] 390 301
4. diagnos*[Title/Abstract] AND (screen*[Title/Abstract] OR scan*[Title/Abstract] OR imag*[Title/Abstract]) 477 486
5. "Point-of-Care Testing"[Mesh] OR "Point-of-Care Systems"[Mesh] 13 267
6. "point-of-care"[Title/Abstract] OR "point of care"[Title/Abstract] 18 130
7. pocus[Title/Abstract] OR "poc us"[Title/Abstract] OR "poc usg"[Title/Abstract] 564
8. portable[Title/Abstract] OR handheld[Title/Abstract] OR hand-held[Title/Abstract] OR mobile[Title/Abstract] OR bedside[Title/Abstract] 155 763
9. 2 OR 3 OR 4 2 956 491
10. 5 OR 6 OR 7 OR 8 174 016
11. 9 AND 10 25 526
Final 1 AND 11 543

 

Cochrane Library via Wiley 2019-10-03
Point-of-care ultrasound in primary care
Search terms Items found
The search result, usually found at the end of the documentation, forms the list of abstracts.; au = Author; MeSH = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; this term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1. MeSH descriptor: [Family Practice] explode all trees 1 968
2. MeSH descriptor: [Physicians, Family] explode all trees 445
3. MeSH descriptor: [Community Health Services] explode all trees 12 948
4. Primary care OR General practi* OR Primary health* OR Community health* OR Family practic* OR Family medicine OR Family physician*:ti,ab,kw 183 741
5. 15 OR 16 OR 17 OR 18 189 823
Intervention:
6. MeSH descriptor: [Ultrasonography] explode all trees 13 513
7. MeSH descriptor: [Diagnostic Imaging] explode all trees 47 308
8. 1 or 2 47 308
9. ultraso* OR sonogra*:ti,ab,kw 41 492
10. diagnos* AND (screen* OR scan* OR imag*):ti,ab,kw 67 926
11. MeSH descriptor: [Point-of-Care Systems] explode all trees 459
12. MeSH descriptor: [Point-of-Care Testing] explode all trees 58
13. 6 OR 7 459
14. "point-of-care" OR "point of care":ti,ab,kw 1 974
15. pocus OR "poc us" OR "poc usg":ti,ab,kw 63
16. portable OR handheld OR hand-held OR mobile OR bedside:ti,ab,kw 14 627
17. 8 OR 9 OR 10 114 364
18. 13 OR 14 OR 15 OR 16 16 237
19. 17 AND 18 2 246
Final 5 AND 19

Cochrane reviews: 277
Cochrane protocols: 19
Trials: 616
Editorials: 0
Special Collections: 1
Clinical Answers: 2		 915

 

Embase via embase.com 2019-10-17
Point-of-care ultrasound in primary care
Search terms Items found
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
Population:
1. 'general practice'/exp OR 'general practitioner'/exp OR 'community care'/exp OR 'primary medical care'/exp 360 883
2. 'primary care' OR 'general practi*' OR 'primary health*' OR 'community health*' OR 'family practic*' OR 'family medicine' OR 'family physician*':ti,ab,kw 637 736
3. 1 OR 2 418 988
Intervention:
4. 'echography'/exp OR 'diagnostic imaging'/exp 933 802
5. ultraso* OR sonogra*:ti,ab,kw 674 628
6. diagnos*:ti,ab,kw AND (screen*:ti,ab,kw OR scan*:ti,ab,kw OR imag*:ti,ab,kw) 756 403
7. 4 OR 5 OR 6 1 810 852
8. 'point of care system'/exp OR 'point of care testing'/exp 13 912
9. 'point-of-care' OR 'point of care':ti,ab,kw 31 560
10. pocus OR 'poc us' OR 'poc usg':ti,ab,kw 1 017
11. portable OR handheld OR 'hand held' OR mobile OR bedside:ti,ab,kw 236 136
12. 8 OR 9 OR 10 OR 11 261 293
Combined sets:
13. 7 AND 12 (intervention) 31 085
14. 3 AND 13 (population AND intervention) 1 358
Study types:
15. 'systematic review'/exp OR 'meta analysis'/exp 309 962
16. systematic* AND review* OR 'meta-analysis' OR 'meta analysis':ti,ab,kw 499 438
17. 15 OR 16 499 438
18. 'randomized controlled trial'/exp OR 'randomization'/exp OR 'controlled study'/exp 7 166 074
19. randomized OR randomised OR randomly OR random OR controlled:ti,ab,kw 2 153 818
20. 18 OR 19 8 262 186
21. 'limit of detection'/exp OR 'sensitivity and specificity'/exp OR 'receiver operating characteristic'/exp OR 'predictive value'/exp OR 'reproducibility'/exp 723 516
22. (sensitiv* OR specific* OR 'limit of detection' OR 'predictive value' OR 'predictive values' OR reproduc* OR 'likelihood ratio' OR 'likelihood ratios' OR reliab* OR 're test' OR retest OR 'test retest' OR 'test re test' OR receiver) AND operating AND characteristic* OR (roc:ti,ab,kw AND (analy*:ti,ab,kw OR curve:ti,ab,kw OR curves*:ti,ab,kw)) 161 604
23. 21 OR 22 751 995
24. 20 OR 23 8 766 917
Final 14 AND 17 (systematic reviews)
14 AND 24 (primary studies)		 60
548
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