Article Figures & Data
Figures
- Figure 1
PRISMA flow diagram.
GP = general practitioner; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; US = ultrasound.
- Figure 2
Use of ultrasound examinations by anatomic area.
ND = not described.
Note: Icons made by Freepik from www.flaticon.com.
- Figure 3
Training in ultrasound examinations by anatomic area.
Note: Icons made by Freepik from www.flaticon.com.
- Figure 4
Diagnostic accuracy of ultrasound examinations by anatomic area.
Note: Icons made by Freepik from www.flaticon.com.
Additional Files
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- Supplemental data: Appendixes - PDF file
The Article in Brief
Point-of-Care Ultrasound in General Practice: A Systematic Review
Camilla Aakjir Andersen , and colleagues
Background Point-of-care ultrasound (the use of ultrasound to diagnose problems wherever a patient is being treated) has been shown to improve diagnosis in hospitals. This study analyzes existing literature about the use of ultrasound by general practitioners and family physicians and their training in ultrasonography.
What This Study Found Family physicians and general practitioners perform ultrasonography for a variety of conditions and with satisfactory levels of accuracy. Ultrasonography has been used for a variety of different conditions, most often focused on abdominal and obstetric ultrasound scans. The extent of training programs in the analysis varied from 2-320 hours. Competence in some types of focused ultrasound scans could be attained with only few hours of training. Focused point-of-care ultrasound scans were reported to have higher diagnostic accuracy and cause less harm than more comprehensive ultrasound scans or screening examinations. In studies assessing quality, participants generally scanned with a satisfactory level of accuracy, with quality depending on the extent of the examination and the anatomical area being scanned. Some focused scans had higher levels of diagnostic accuracy, required less training and were associated with less harm, whereas more extensive examinations were associated with lower quality scans and potential harms.
Implications
- The authors anticipate that point-of-care ultrasound will be increasingly important for family physicians/general practitioners in diagnosis, choice of treatment, and referral. These study results, they note, can help inform curricula and future exploration of the use of point of care ultrasound in family medicine/general practice.
Annals Journal Club
Jan/Feb 2019: Point-of-Care Ultrasound as a Tool for Family Medicine
Kathryn Rooney, BA, Rush Medical College
The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article and click on "TRACK Discussion/ Submit a comment.") Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
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(1):61-69.
Discussion Tips
Point-of-care ultrasound (POCUS) is a low cost, accessible imaging modality. Despite its growing popularity, POCUS training in family medicine residencies is limited and it is used by less than 10% of practicing family physicians for nonobstetrical examinations.2,3 This systematic review provides an opportunity to review the published literature on the use of and training for POCUS among general practitioners.
Discussion Questions
- What is a systematic review? What is a meta-analysis? How are they related?
- What is the Cochrane Collaboration? What is PRISMA?
- What questions are asked by this review?
- Were appropriate studies included in the authors' search?
- How were studies included or excluded? Were included studies relevant to the authors' question?
- What are the main findings?
- Were any meta-analyses completed? If not, why?
- What are sensitivity and specificity?
- What is the well-established problem of screening in a population with low pretest probability? What are false positives and why is this a relevant concept?
- How does this review advance beyond previous research and clinical practice on this topic?
- How might this review change your practice? How might it influence graduate medical education?
- How feasible is point-of-care ultrasound for your practice?
- What clinical applications of POCUS are most/least relevant to your practice?
- What future research would be most valuable to pursue?
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.
- Hall JW, Holman H, Bornemann P, et al. Point of care ultra-sound in family medicine residency programs: a CERA study. Fam Med. 2015;47(9):706-711.
- Clinical Procedures Performed by Physicians at their Practice (as of December 31, 2017). https://www.aafp.org/about/the-aafp/family-medicine-specialty/facts/table-12(rev).html. Accessed Dec 13, 2018.
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